I was in Whole paych...er Foods the other day and overheard a woman telling another woman to buy some supplements to help her allergies, naturally. I was trying not to creep too hard but they were standing in front of the wall of vitamin C options, which led me to be curious what actual evidence there was, seeing as I don't often hear about nutrition and allergic rhinitis/sinusitis. It's pretty common to hear complaints about seasonal allergies/hay fever at this time of year, and in my general google searches, I saw some potentially misleading reports about 'natural' tips for managing them, even on sites such as WebMD (1).
The WebMD article talks about using 'nature-based' products, such as butterbur, herbs, quercertin and vitamin C. While some studies support it's effectiveness, Butterbur has liver safety issues related to its pyrrolizidine alkaloid (PA) content, and PA-free should always be recommended (WebMD's did not mention this); Butterbur has also had a number of negative symptoms associated with it, including itchy eyes and asthma (isn't that what we're not going for?) (2). Goldenseal has little evidence supporting it's effectiveness for any medical condition (3), and it's active component that has been studied, berberine, which alternative health practitioners rely on to make their claims, exists in small quantities in goldenseal, and has very low bioavailability (4). Claims made about quercetin, a flavanoid commonly found in the skins of fruits, are taking histamine-inhibition data from human mast cell lines and extrapolating this to mean that taking quercetin supplements will give the same effect (5) - no RCT's have been done to prove the benefit of quercetin.
Claims regarding the efficacy of natural remedies for allergies made by unqualified practitioners/internet are a bit misguided, and will likely send you down a path of wasting your ca$h on unnecessary supplements. For a good read on the topic, check out sciencebasedpharmacy's article here.
So, are there any nutrition therapies that are effective? Unfortunately, the data is limited and disappointing:
1. Breastfeeding - unfortunately, probably the most effective thing you can do to prevent symptoms of allergic rhinitis is to have been exclusively breastfed for the first 3 months of life (6). Thanks mom...
2. Omega 3's - Many will tout the benefits of long chain n-3's (EPA/DHA) for their allergy benefits. It makes sense, given their anti-inflammatory effects. Several associations exist (7,8) between EPA/DHA intake/membrane contents and allergic rhinitis, and these are often cited. However, the only double blind placebo controlled trial, which only supplemented with EPA (3.2g/day), found no benefit for prevention of seasonal hay fever (9).
3. Lots of Associations - apart from the associations found between Omega 3's and allergic rhinitis, a number of others have been shown as well. Regular intake of fruits and vegetables has been associated with a reduced incidence of shortness of breath/wheezing (10). Prevalence of allergic rhinitis has been inversely associated with plasma total carotenoids, though single carotenoids, tocopherols, and vitamin C plasma values were unrelated (11). Gamma-tocopherol was negatively associated with allergic rhinitis, which I found interesting because gamma-tocopherol can lead to endogenous Nitric Oxide production (12), a pro-inflammatory molecule thought to worsen allergic rhinitis/asthma symptoms (13). We can't draw too much from associations, as they don't tell us much about the other lifestyle/genetic factors that play a role in all of this. Unfortunately, most google'ings of nutrition and allergic rhinitis base recommendations solely off of this data.
4. Vitamin E - huge levels of vitamin E supplementation (800mg/day, compared to the DRI of 15mg/day) resulted in lower, reported levels of nasal symptom scores (but not ocular). This supplementation was done in conjunction with anti-allergy treatments and there was no reduction in the use of medication, or duration of symptoms, regardless of supplementation. If it's not reducing need for medication, I'd question the need for supplementation to just reduce your perceived symptoms.
What does all of this translate to? Follow the recommendations of your primary care provider/pharmacist. If normal treatment is not effective or you are having adverse side effects, discuss the potential use of PA-free butterbur. As far as nutrition goes, eat a diet following the current recommendations, that support consuming a variety of plant foods, 7+ servings of fruits/vegetables per day, and including fatty fish or a DHA/EPA supplement. There is no sound evidence that dietary or nutritional therapies can adequately control seasonal allergies, and evidence is suggestive, at best, that maintaining a healthy diet can help prevent/mitigate symptoms.
1. http://www.webmd.com/allergies/features/relieve-allergies-natural-way
2. http://nccam.nih.gov/health/butterbur
3. http://nccam.nih.gov/health/goldenseal
4. http://www.ncbi.nlm.nih.gov/pubmed/21637946
5. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0033805
6. http://www.ncbi.nlm.nih.gov/pubmed/12022298
7. http://www.ncbi.nlm.nih.gov/pubmed/16015268
8. http://www.ncbi.nlm.nih.gov/pubmed/17634174
9. http://www.ncbi.nlm.nih.gov/pubmed/8484622
10.http://www.ncbi.nlm.nih.gov/pubmed/14621084
11. http://www.ncbi.nlm.nih.gov/pubmed/16870019
12. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC45961/
13.http://www.ncbi.nlm.nih.gov/pubmed/9876773
14. http://www.iom.edu/~/media/Files/Activity%20Files/Nutrition/DRIs/DRI_Vitamins.pdf
The WebMD article talks about using 'nature-based' products, such as butterbur, herbs, quercertin and vitamin C. While some studies support it's effectiveness, Butterbur has liver safety issues related to its pyrrolizidine alkaloid (PA) content, and PA-free should always be recommended (WebMD's did not mention this); Butterbur has also had a number of negative symptoms associated with it, including itchy eyes and asthma (isn't that what we're not going for?) (2). Goldenseal has little evidence supporting it's effectiveness for any medical condition (3), and it's active component that has been studied, berberine, which alternative health practitioners rely on to make their claims, exists in small quantities in goldenseal, and has very low bioavailability (4). Claims made about quercetin, a flavanoid commonly found in the skins of fruits, are taking histamine-inhibition data from human mast cell lines and extrapolating this to mean that taking quercetin supplements will give the same effect (5) - no RCT's have been done to prove the benefit of quercetin.
Claims regarding the efficacy of natural remedies for allergies made by unqualified practitioners/internet are a bit misguided, and will likely send you down a path of wasting your ca$h on unnecessary supplements. For a good read on the topic, check out sciencebasedpharmacy's article here.
So, are there any nutrition therapies that are effective? Unfortunately, the data is limited and disappointing:
1. Breastfeeding - unfortunately, probably the most effective thing you can do to prevent symptoms of allergic rhinitis is to have been exclusively breastfed for the first 3 months of life (6). Thanks mom...
2. Omega 3's - Many will tout the benefits of long chain n-3's (EPA/DHA) for their allergy benefits. It makes sense, given their anti-inflammatory effects. Several associations exist (7,8) between EPA/DHA intake/membrane contents and allergic rhinitis, and these are often cited. However, the only double blind placebo controlled trial, which only supplemented with EPA (3.2g/day), found no benefit for prevention of seasonal hay fever (9).
3. Lots of Associations - apart from the associations found between Omega 3's and allergic rhinitis, a number of others have been shown as well. Regular intake of fruits and vegetables has been associated with a reduced incidence of shortness of breath/wheezing (10). Prevalence of allergic rhinitis has been inversely associated with plasma total carotenoids, though single carotenoids, tocopherols, and vitamin C plasma values were unrelated (11). Gamma-tocopherol was negatively associated with allergic rhinitis, which I found interesting because gamma-tocopherol can lead to endogenous Nitric Oxide production (12), a pro-inflammatory molecule thought to worsen allergic rhinitis/asthma symptoms (13). We can't draw too much from associations, as they don't tell us much about the other lifestyle/genetic factors that play a role in all of this. Unfortunately, most google'ings of nutrition and allergic rhinitis base recommendations solely off of this data.
4. Vitamin E - huge levels of vitamin E supplementation (800mg/day, compared to the DRI of 15mg/day) resulted in lower, reported levels of nasal symptom scores (but not ocular). This supplementation was done in conjunction with anti-allergy treatments and there was no reduction in the use of medication, or duration of symptoms, regardless of supplementation. If it's not reducing need for medication, I'd question the need for supplementation to just reduce your perceived symptoms.
What does all of this translate to? Follow the recommendations of your primary care provider/pharmacist. If normal treatment is not effective or you are having adverse side effects, discuss the potential use of PA-free butterbur. As far as nutrition goes, eat a diet following the current recommendations, that support consuming a variety of plant foods, 7+ servings of fruits/vegetables per day, and including fatty fish or a DHA/EPA supplement. There is no sound evidence that dietary or nutritional therapies can adequately control seasonal allergies, and evidence is suggestive, at best, that maintaining a healthy diet can help prevent/mitigate symptoms.
1. http://www.webmd.com/allergies/features/relieve-allergies-natural-way
2. http://nccam.nih.gov/health/butterbur
3. http://nccam.nih.gov/health/goldenseal
4. http://www.ncbi.nlm.nih.gov/pubmed/21637946
5. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0033805
6. http://www.ncbi.nlm.nih.gov/pubmed/12022298
7. http://www.ncbi.nlm.nih.gov/pubmed/16015268
8. http://www.ncbi.nlm.nih.gov/pubmed/17634174
9. http://www.ncbi.nlm.nih.gov/pubmed/8484622
10.http://www.ncbi.nlm.nih.gov/pubmed/14621084
11. http://www.ncbi.nlm.nih.gov/pubmed/16870019
12. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC45961/
13.http://www.ncbi.nlm.nih.gov/pubmed/9876773
14. http://www.iom.edu/~/media/Files/Activity%20Files/Nutrition/DRIs/DRI_Vitamins.pdf
If someone came here in search of a natural remedy to seasonal allergies, I take one drop each of lemon, lavender and peppermint essential oils (therapeutic grade - safe for ingestion and NOT synthetic) diluted in water. I do this during an "allergy attack" and my symptoms are gone within 15 minutes. The effects will last up to 5 hours before returning. I have battled allergies my whole life and this remedy works better than any medicine I have tried as well as allergy shots. Another remedy is to find a local (within 15 miles of your home) honey producer and take 1 tablespoon per day. That will greatly reduce your allergy symptoms over time.
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