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  Excess inflammation leads to worsening symptoms. When we minimize inflammation, we minimize symptoms.

  INFLAMMATION AND ILLNESS

  Let’s look at a specific example, an eight-year-old girl named Sara. Sara has eczema, asthma, allergies, chronic runny nose, and constipation; eats the standard American diet (SAD) of processed foods (high sugar content and artificial dyes); has environmental allergies to trees and grasses; and lives in an area with high levels of air pollution. You can see in the image below that she has a significant amount of systemic inflammation and her glass of water is overflowing, which prevents her immune system from working effectively and efficiently.

  Since we can’t cut down all the trees and dig up all the grasses, we look at the aspect of Sara’s environment that we have the most control over: food. We minimize her processed and packaged foods; add in more vegetables, healthy fats, and proteins; replace high-sugar drinks with water; and remove dairy from her diet.

  SARA’S CUP OF INFLAMMATION

  As we begin to decrease systemic inflammation, the glass will go from overflowing down to half-full or less. Sara’s cellular health improves. This somewhat decreases the impact the air pollution and environmental allergies have on her body. When spring and fall allergy seasons come along, or Sara is exposed to more pollution or a virus, her inflammation goes up and her glass starts to fill, but now it’s only three-fourths full. For a change, she may get through allergy season with little to no allergy medication and she may not need her albuterol rescue inhaler as much as she did the previous seasons. Possibly even the MiraLAX she’s been taking for two years for constipation is no longer needed.

  The higher the amount of baseline inflammation, the longer it may take to get the inflammation under control. Sometimes this means adding more medications or supplements at first to treat the child’s illness and to strengthen her immune system.

  Sounds simple, right?

  The concept of inflammation and illness is simple, but the body and all of its moving parts are complex. We also have to consider all the other aspects of a child’s environment in order to bring her inflammation to a minimum.

  INFLAMMATION:

  Three Major Concepts

  I’d like to introduce you to three major concepts regarding inflammation, which I wish I’d learned in medical school. In the next several pages, I’ll teach you what it took me over fifteen years to learn!

  Most physical symptoms of illnesses stem from inflammation.

  Physical signs and symptoms of inflammation are often related.

  Five things trigger inflammation in our bodies. Food

  Environmental allergies

  Environmental toxins

  Infectious diseases

  Stress

  It is the interaction of our genes with these triggers that determines our overall health. Our bodies don’t have fences. Inflammatory cells can travel anywhere in the body, from the gut to the brain to the skin. Therefore, poorly controlled asthma is related to constipation and stomachaches. Recurrent ear infections are related to uncontrolled eczema. This also applies to our central nervous system. Have you ever noticed that your child’s behavior is worse if he has gone three or four days without a bowel moment? Or at the height of allergy season, does he seem more irritable? If a child has tics, I often see them worsen during allergy season.

  MAJOR CONCEPT 1:

  Most Physical Symptoms of Illness Stem from Inflammation

  By now, you are familiar with the list of inflammatory illnesses in kids: reflux, eczema, keratosis pilaris (bumps on the back of the arms), recurrent ear or sinus infections, chronic runny nose, allergies, asthma, stomach pain, and constipation or loose stools.

  Some signs of these illnesses may be more obvious than others. We can easily see the skin and the inside of the nose, but it’s harder to get a clear picture of what’s going on inside the body. Acne and eczema are easy to see, whereas the cause for wheezing takes a little more work to discover because the inflammation is deeper and not visible to the unaided eye.

  The prevalence of coexisting conditions is why I always talk about the “constellation of symptoms.” Some of the more obvious signs of inflammation can guide us into understanding the deeper inflammation that might be happening with your child. The subtler, more “silent” types of inflammation can fester undetected for years, which can also cause consequences later in life.

  An example of this silent inflammatory process in adults is heart disease. Doctors now know that heart disease (more accurately termed cardiovascular disease) is related to chronic inflammation, which causes plaque buildup in arteries. It takes years to build up enough plaque to obstruct arteries, but when an artery that supplies blood to the heart is finally blocked, it can no longer supply enough blood and oxygen to the heart muscle, leading to a heart attack.

  The underlying signs of inflammation may not be obvious either until it’s too late, as with a heart attack or stroke (which is the same process as with the heart, but instead the vessels are blocked in the brain), or until it has been building up for years, damaging the tissues and hindering the ability of the heart to pump blood effectively.

  Another disease that can provide insight about underlying inflammation is asthma. Asthma can seem elusive and below the surface if you don’t understand how pervasive and irritating the inflammatory cells are to the lungs in an individual who wheezes. Patients with asthma often have many more visible signs of inflammation, such as eczema, bumps on the backs of the arms (keratosis pilaris), dark circles under the eyes, chronic nasal congestion, runny nose, and constipation.

  Please bear with me here even if your child doesn’t have asthma. This discussion provides some important information that will give you a broader understanding of inflammation, disease, and health.

  Asthma is characterized by excess inflammation in the body, the lungs in particular. When a child with asthma is exposed to one of her “asthma triggers,” such as tree pollen, tobacco smoke, or even a virus, her immune system says, “Hello, invader! Let me send an army of cells to the lungs, so I can get rid of you!”

  The body then sends a whoosh of white blood cells (mucus) to the lungs. The mucus irritates the muscles in the airways and causes them to constrict. This constriction is what leads to wheezing. It’s a complex dance among allergies, the immune system, genetics, and inflammation, as we’ll see in Gary’s case. As you read it, you’ll notice the five triggers of inflammation.

  CASE STUDY

  GARY

  SYMPTOM: RECURRENT WHEEZING

  Gary was four years old when his mother brought him to see me. He’d had a persistent cough for several months. Throughout the previous two years, he’d had recurrent bouts of coughing, runny nose, and wheezing that required an albuterol inhaler. For the wheezing, he’d taken one course of oral steroids, which he did not tolerate. His behavior became erratic, with irritability, mood swings, and sleep troubles.

  At that point, his mother knew she never wanted him to take oral steroids again. She decided to switch to an integrative pediatrician. She felt the conventional medical approach was aimed at treating his symptoms, and her intuition was telling her his chronic cough and congestion had some underlying cause that wasn’t being addressed.

  Gary’s mother and I combed through his history. As an infant, he had been extremely fussy and colicky and later developed recurrent bouts of wheezing, coughing, and chronic nasal congestion. During his office visit, I observed that he was a mouth breather; he had a runny nose and dark, puffy circles under his eyes; and his breathing was audible (which I affectionately call “Darth Vader breathing”). All of these signs indicated uncontrolled systemic inflammation.

  On exam, the inside of his nose (nasal mucosa) was pale in color, almost bluish, and swollen shut, which made him a mouth breather.

  Environmental allergies often cause the nasal mucosa to be pale and swollen. As luck would have it, Gary’s previous pediatrician had done allergy testing through bloodwork
and discovered a severe dust mite allergy. My first question when a child has a dust mite allergy is: How old are his mattress and pillows?

  Mattresses and pillows are dust mite havens. One study, conducted at a London hospital, suggested that up to a third of a pillow’s weight could be made up of bugs, dead skin, and dust mites and their feces.

  Gary happened to be sleeping on a fifteen-year-old mattress from his uncle’s college days. Given the severity of his dust mite allergy, his mother and I decided they should invest in a new mattress and pillows. Then they could put plastic covers over them to prevent dust mites from settling into them. These covers would help us keep Gary’s dust mite exposure to a minimum while he slept.

  MAJOR CONCEPT 2:

  Physical Signs and Symptoms Are All Related to One Another

  Our traditional medical system has moved toward treating symptoms, and looking at the body, in a reductionist fashion. A person will see a dermatologist to prescribe steroids for eczema, an ENT doctor for ear tubes, and then a gastroenterologist for a laxative prescription for constipation. This routine is typical for many of my patients.

  Often, doctors are treating symptoms of illness instead of figuring out the root of the illness. And while it may sound as if I’m pointing a critical finger at conventional medicine, I’m not. As I’ve previously stated, conventional and integrative medicine are equally important. But I’m saying that we physicians must take a step back and look at our training. Doctors are trained to find exactly where a tumor is and how to either remove it with surgery or shrink it with chemotherapy. A great deal of research money goes toward treatments. However, we need more research on what may have triggered the tumor growth in the first place and what type of nutrition and lifestyle modifications might help support the patient’s body to get through the treatment more smoothly and possibly prevent it from reoccurring.

  I liken my job as a physician to that of a car mechanic. I need to look beneath the hood and, when possible, remove or resolve whatever is causing the symptoms. If my car had a recurrent issue—let’s say the headlights kept going out—I’d take it to a mechanic. If he fixed it and two weeks later the lights went out again, I’d take the car to a different mechanic, perhaps one who specializes in the electrical circuitry of cars. This mechanic will get in there, figure out where the wiring is off, and fix it, while helping me understand the bigger picture of the problem. I’d continue to go to my original mechanic for oil changes and other maintenance, but if I have a more complex or recurring problem, I might go to a mechanic who has more time, a different toolbox, and more diagnostic equipment.

  Most physicians prefer to figure out the underlying cause of an illness, including me. In conventional medicine, however, we often have little time with patients. My medical training emphasized the “allergy march.” This refers to the natural history or typical progression of allergic diseases that often begin early in life and include atopic dermatitis (eczema), food allergy, allergic rhinitis (runny nose due to allergies), and asthma. My tools for controlling symptoms at that time were antihistamines and steroids. At that time, I didn’t understand about cumulative inflammation and its five triggers. Of the five, I knew the least about how inflammatory foods could, in some cases, worsen allergy symptoms.

  Many of you have been reading about nutrition, researching supplements, and asking your pediatricians for advice. Before I did my integrative medical training, bringing your child to me and asking nutrition and supplement advice was like taking your electric car to a diesel mechanic. Both mechanics know engines, but the tools they use are somewhat different. I simply didn’t have enough (or any) nutrition training to really give any advice. But I also didn’t know nutrition could even be playing a role. I just knew I needed to ask whether the child was eating vegetables and drinking two to three cups of milk per day.

  When I was first out of residency, I used medications to treat the symptoms of the allergy march with patients like Gary. I would have prescribed an inhaled steroid for him, along with an antihistamine for allergies, a topical steroid for the eczema, and a nasal steroid spray for his runny nose. This would have addressed most of his inflammatory symptoms during the time of year when his allergies and asthma flared up the most. If he had constipation on top of all that, I would have also given him a laxative.

  When I know a child has an increased risk of asthma or any other type of inflammatory issue like allergies, constipation, or reflux, I now look at the bigger picture and ask, How can I reduce this child’s overall systemic inflammation?

  I then utilize the system I’ve developed based upon my integrative medical training and years of experience in pinpointing what may be triggering a child’s wheezing—the very system you’re learning about in this book.

  MAJOR CONCEPT 3:

  Five Things Trigger Inflammation in Our Bodies

  Keep in mind that we all have differences in our underlying genetics that impact the way we respond to everything in our environment, from foods to viruses to stress. Think about the five triggers as anything in our environment that our bodies can react to.

  Let’s go back to Gary’s case. For kids who wheeze at a young age, we stratify them into risk categories: those who will likely go on to develop asthma and those who will just wheeze until they are about two or three years old with colds, but then they will outgrow it. Given Gary’s symptoms, as well as his family history of asthma, he was in the highest risk category and was almost ten times more likely to develop persistent asthma.1

  Gary’s signs of inflammation can be classic for someone with a dairy sensitivity and also for an environmental allergen such as dust mites. We identified ways we could decrease his systemic inflammation—to get his wheezing, runny nose, and cough under control—starting with two of the five areas of inflammation: food and environmental allergies.

  TRIGGER HOW WE DIAGNOSED HOW WE TREATED

  Food My professional experience indicated that dairy was most likely contributing to his overall systemic inflammation. We eliminated dairy, since he had a classic history of a cow-milk protein sensitivity, which caused colic, reflux, and a chronic runny nose. We also added some key supplements including probiotics, vitamin D, fish oil, magnesium, and a whole food supplement.

  Environmental Allergies An IgE Environmental Allergy Profile was done through bloodwork. This can also be done by an allergist with skin prick testing. He had a severe dust mite allergy, so his parents got rid of the old mattress and pillows he was sleeping on.

  Environmental Toxins Nothing in his medical history made me suspicious of an environmental toxin; therefore, we did not test. We didn’t need to address anything in this category with him.

  Infectious Diseases I diagnosed Gary with walking pneumonia at his first visit by listening to his lungs. We treated this with an antibiotic. If I had suspected a more serious type of pneumonia, I would have referred him for a chest x-ray. Gary’s wheezing episodes were triggered by two main things: his allergies (dust mites) and viruses (infectious microorganisms). Once we removed inflammatory triggers like milk and dust mites, his systemic inflammation decreased, and his immune system became more efficient and effective at fighting off viruses and bacteria.

  Stress Lack of sleep increases stress to the child’s system and holds them in the sick cycle because it dampens their immune function. In Gary’s case, his sleep deprivation also manifested in behavioral issues. So, while Gary wasn’t sleeping, neither were his parents, and everyone’s glass of stress was overflowing! We shifted Gary out of crisis mode, which lifted him out of the sick cycle and significantly decreased his and his parents’ stress level.

  At his follow-up appointment three weeks later, Gary’s chronic nasal congestion and cough had almost completely resolved. Eventually, the dark circles under his eyes disappeared, as did his mouth breathing. His need for albuterol decreased.

  FIVE TRIGGERS OF INFLAMMATION

  GARY’S CUP OF INFLAMMATION

  Gary improved rapidly, and to this day, h
e is doing great. He is one of hundreds of children whom I have seen over the years who have enjoyed an improved path with their wheezing or asthma after we methodically worked to decrease their systemic inflammation.

  I’ve heard this question many times from parents: why didn’t anybody tell us that food could be contributing to the illness? My response is always the same: when I trained, nutrition wasn’t part of the curriculum. If I’d seen your child before I started studying nutrition and integrative medicine, I would’ve given you the same advice your previous pediatrician gave you.

  Gary’s situation was straightforward. The dark circles under his eyes and his Darth Vader breathing are easy to identify in kids and adults when you know what you are looking for. But some cases are more complex and require further probing. One of my goals with this book is to help you see and identify the inflammation in your child, so it can be resolved sooner.

  TAKEAWAYS

  Life is made up of a set of complex variables impacting us at all times, including illness. By breaking down the main triggers of inflammation into an easily understood, organized fashion, you can begin to understand how to gain control of your child’s health.

  The important thing is to be pragmatic and remember that each trigger of inflammation carries equal weight. If we address one area with 100 percent effort but ignore the others, you may not see the true health transformation you’re seeking for your child.