The Fall and Rise of Asthma

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Since 1980, the number of Americans suffering from asthma has doubled. Asthma has become a problem for 15 million people in the US and 5 million of those are children. Asthma affects slightly more females than males, slightly more blacks than whites and the poor more than the rich. The death rate is the highest for older people, but children report the most attacks. And, infants up to 4 years of age seem to be on the sharpest growth curve. Over 100 million work, play and school days are lost each year to asthma making it the number one cause of absence. The estimated yearly costs of the disease are approaching 15 billion dollars. The CDC (Centers for Disease Control) has a well-funded program to study asthma, doctors are fighting the disease, newspapers report the alarming trend and people are aware. Yet the problem grows.

Some of the most stunning statistics are presented in the "Asthma Prevalence by Age" and "Asthma Death Rate" graphs compiled from government data. Most of the attention seems to have been given to the rise in asthma since 1980. But to me, it is more amazing that asthma death rates were falling in the 1960’s, leveled off in the 1970’s and then started to rise. Something good was going on prior to 1970 and it either stopped or was dominated by something bad that has gone on ever since. What about music? When did the Beatles break up? How many years has MTV been around? Sorry, I thought I was on to something.

Everybody knows that people with asthma have trouble breathing. But, what exactly happens? Asthma is an allergic (or allergic-like) reaction to an environmental or emotional trigger. The body responds with swelling, inflammation and mucus in the lungs. This affects breathing out more than breathing in. Asthmatics have trouble getting the air out of their lungs because of the swelling. So, they must breathe with quick and shallow puffs during an attack. Asthma triggers include allergy, infection, pregnancy, emotions, exercise, air pollution, tobacco smoke, dust, cockroach protein, chemicals and sulfites. I’ll bet you were wondering when I was going to get to sulfites. So, what combination of these triggers decreased for a while and then increased? That’s the 15 billion dollar question.

It’s only been 50 years since 1960. Things have changed, but not radically. After all, automobiles, airplanes, rockets, television and radio all existed in 1960. So, most of the asthma triggers are probably not responsible for the fall and rise of asthma during this period. I would tend to rule out infections, pregnancy, emotions and exercise on this basis. However, allergy deserves a closer look, especially since it is a significant trigger. I have read that allergy treatment is on the rise in America. Whether or not that means that allergy as a disease is more prevalent, I don’t know. It is quite possible that the low cost of HMO visits or the publicity of allergy medicines has increased the number of people seeking help for allergies. However, if you assume that allergies are expanding, you must conclude that either people are becoming more sensitive or that the environment is becoming more hostile. It’s hard to imagine that people are changing, so let’s take a look at our environment and the remaining asthma triggers.

Air pollution is the most obvious villain. We have spent lots of time and money cleaning up the environment and I would expect some real change here. If not, I want some of my tax money back. A graph showing national levels of carbon monoxide, nitrogen oxide, volatile organics, sulfur dioxide and particulate matter shows the results of this effort. This data was obtained from the FDA Emission Trends Report (1900-1996). For some pollutants, there has been a steady decline since 1960. For others, there seems to be a peak around 1970 with a decline since then. None of these profiles tracks asthma; as a mater of fact, air pollution seems to have been the worst when asthma rates were lowest. And as pollution improved, asthma worsened. This is backwards and suggests pollution has little to do with the fall and rise of asthma in the recent past.

What’s next: tobacco smoke. Shown is a graph of data from the National Center for Health Statistics (NCHS) plotting the percentage of the US population with a cigarette habit over the last 30 years. As you might guess, the smokers have steadily declined from 42% to 24%. The tobacco companies must really be hurting. And, it goes a long way toward explaining the drop in asthma problems prior to 1970. I think you could make a very convincing argument that the combination of improvements in medical science and falling tobacco use resulted in a decline in asthma up to 1970. What happened then? Perhaps an even stronger trend gained strength and eventually dominated the gains from science and smoking. So, let’s look for a trigger that has been on a strong growth path since 1970.

What about dust? I live in the windy hills north of Los Angeles where there is a lot of dust. But there always has been and I don’t notice it increasing. A phenomenon called fugitive dust has gained attention recently. Fugitive dust is generated in a land far, far away. The dust is picked up by weather patterns and transported hundreds, even thousands of miles before settling. It is claimed that a unique red dust from Africa can make it all the way to the United States. Since this is a new subject, it has been studied for only ten years. In that time frame, it appears to have slightly declined. At any rate, it doesn’t seem a strong candidate for causing asthma growth. Particulate matter might be considered a form of dust and it is graphed along with the air pollutants. If you look closely at that curve, you will notice that particulate matter has steadily declined since 1960. I don’t think dust is responsible for asthma growth.

I have heard it suggested that cockroaches will be the big winners in a nuclear war. Well, that was the talk before Russia folded. Anyhow, cockroaches are everywhere; they are certainly in my garage. I suppose they are more prevalent in poor neighborhoods where the asthma rates are slightly higher. And, cockroach proteins are asthma triggers. But, have cockroaches increased so much in the last 30 years to wipe out all the gains of medical science and the benefits of tobacco reduction? That seems a bit unlikely.

Industrial chemicals can cause asthma if the chemicals are volatile and inhaled. The chemicals most often cited include toulene diisocyanates, trimellitic anhydrides, enzymes and I’m sure there are many more. But, OSHA has been active in recent years trying to minimize industrial hazards. So, although there might be growth in the use of chemicals by industry, there should be an even stronger decline in workplace exposure or the OSHA folks aren’t doing their jobs. Among chemicals used for medication, aspirin can trigger asthma as can other non-steroidal remedies such as ibuprofen. More than 5% of asthma sufferers have a problem with aspirin. But we are looking for a cause that affects small children as well as adults and aspirin is strongly discouraged for use by children under 12 because of Reye Syndrome. The aspirin alternative in Baby Tylenol, acetaminophen, is not an asthma trigger nor a cause of Reye Syndrome.

There is one broad argument concerning chemicals that may have some merit. As part of the environmental movement, many homes have become better insulated to prevent heat loss and conserve fuel. As a consequence, air inside such homes is less often cleansed by outside air and chemical pollutants are concentrated within the home. This might apply to fumes from paint, plastic, fabric or allergens from mites, mice and cockroaches. Although such an effect is probably real and cannot be ignored, it probably applies more to the affluent than the poor. After all, it costs money to insulate and landlords of low income apartments would be least likely to open their wallets. So, let’s take a look at something that affects rich and poor, young and old, male and female, white and black. Let’s look at sulfur preservatives.

Sulfites are known to trigger attacks in at least 5% of asthmatics. Most asthmatics are not allergic to sulfites, just sensitive to them. This implies that a sulfite acts like a mild poison and prompts sensitive body tissue to swell. The more poison, the more the swelling. At some critical level, an asthmatic starts to have trouble breathing, which further irritates the system and initiates an attack. It would seem likely that at even low doses, sulfites would cause tissue swelling although not enough for anyone to notice. This is what happens in my body when I ingest sulfites. My sensitive area is not the lungs; it is the head. So, I don’t get asthma; I get a headache. The more sulfites I consume, the more I can feel pressure build behind my eyes. If I get a large enough dose, pain develops. The larger the dose, the more the pain. The effect seems quite linear in my system, until I start banging my head against the wall and stop taking notes.

So, here’s my theory. Sulfites and sulfur dioxide are present in an unbelievably wide range of American food. And, sulfur preservatives have been on a growth curve as food distribution habits have evolved over the past 50 years. Today, food from a single manufacturer can wind up on every grocery shelf in the country. That food must be preserved in some manner or it won’t look good and it won’t sell. The salad bar incidents of the 1980’s document the increased use of sulfites 30 years ago. But, because of those incidents, current regulations discourage the use of large amounts of sulfite. Today, the problem is low levels of sulfur dioxide in practically everything you touch. This doesn’t cause dramatic anaphylactic seizures, but it does cause tissue swelling in many people. If you are an asthmatic and you are walking around with slightly swollen lungs, you are going to be more susceptible to all asthma triggers. To me, this seems obvious but it is the one leap of faith in my argument. So, in short, I am suggesting that sulfur preservatives are playing a large roll in the current explosion of asthma cases.

Packaged and convenience foods are eaten by everyone in the United States. This includes all sexes, all races, all ages and all regions. So, if we can only show that sulfur preservatives have been on a continous growth curve for the past 30 years, we have a pretty strong argument for a connection between asthma and the Brimstone Demons. Let’s look at a few more graphs. One of my favorites shows yearly soft drink consumption on a per person basis. I should have bought stock in Coke or Pepsi a long time ago. Oh well. Soft drinks come in many varieties, regular and diet, cola or uncola, brown or clear. The ones that contain the most  oxides of sulfur are colored brown by Class IV caramel color. This includes regular colas, diet colas and root beers which account for 80% of all soft drinks. Shown is a graph of soft drink consumption (diet and regular) for the past 30 years. You will notice that since 1970, soft drink consumption has more than doubled from 24 to 53 gallons per year. Do you drink that much cola? I’ll bet your kids do. By our earlier calculations, colas contain over 100 ug of effective sulfur oxide per can, enough to give me a headache.

What else has been growing over the past 30 years? Refined corn, of course. This includes regular and high fructose corn syrup, dextrose, cornstarch and maltodextrin. Corn syrup is the number one sweetener in the US, outselling cane and beet sugar combined. Traditional and slightly sweet corn starches have found a niche in the gigantic low-fat market. If you examine food labels, you will find a refined corn product in practically everything in the modern grocery store. Grapes are popular, too. Even if we disregard wine, grape and raisin consumption has grown. And, grape juice concentrate is widely used as a sugar replacement in jellies, jams, candy and fruit drinks.  The graphs below show this trend quite dramatically.  Note they are graphs of consumption for an average American in any given year.  To calculate total consumption for all Americans, you would have to mulitply these values by the population.

What about potatoes? Processed spuds account for 50% of the potato crop and include the fries that burger stands use along with dehydrated instant potatoes and frozen products. All of these items have enjoyed a boom in recent years and they all contain sulfites or sulfur dioxide. What more evidence do we have? Good old pizza. Sulfites are used in most pizza dough as conditioners. Now pizza consumption is a little harder to track unless you look at mozzarella cheese production. Most mozzarella cheese is used for pizza and mozzarella consumption has grown from 3.1 pounds per person in 1980 to 7.9 pounds in 1995. This figures out at a 6% annual growth rate and agrees nicely with bragging from within the pizza industry. In 1996, 23 pounds of pizza was eaten by every man, woman and child in the US. Wow, I suddenly got a touch of heartburn. If you scramble all of the numbers together, you will find that pizza has quadrupled in the same period that asthma has become more problematic.

Applying effective sulfur oxide concentrations to all of this data seems like a lot of work. But, I have a computer and it is very patient. The final result is shown below as a graph of effective sulfur oxide consumption since 1970 for brown cola, refined corn, grape (not including wine), processed potato and pizza. This doesn’t cover everything but it does pick up the major uses of sulfur preservatives. What does it mean? The Brimstone Demons are not an endangered species. The average daily exposure to sulfites has been rising steadily since 1970. I should emphasize that these are averaged numbers that just give a rough idea of the relative amount of sulfur dioxide in the grocery store in any given year. An individual’s actual consumption of sulfites may be wildly different on any single day. Only the average of all people over all days for a subset of foods is actually plotted on the graph. And since all food groups are not represented, actual sulfite consumption will be higher than shown on the graph. (As you will see by analyzing typical diets, the graph probably addresses only about half of the effective sulfur oxides in the modern world.)  On the one hand, imagine a grandma eating oatmeal, toast, chicken soup, crackers, rice and coffee. As a contrast, imagine a Little League short-stop eating raisin bran, a burger with fries, pizza, candy and 3 colas. Guess which one winds up in the asthma clinic?

The graph above is a good indicator of the trend in effective sulfur oxide exposure. But, what about some real world examples that would apply to daily life. Although, I am sensitive to sulfites at the 100 microgram level, it is quite unlikely that most people would be this hyper-sensitive. I have heard estimates that most asthmatics have a threshold of 3000 micrograms or higher. So, let’s accept 3000 as a lower benchmark and examine a few diets to see how they compare to this threshold. As a first example, we’ll throw caution to the wind and eat like a pig on vacation. Then we’ll be more conservative and look at a common school day for a child. The diets are presented in tables below with estimated sulfur oxide levels shown for each meal. The numbers were calculated using the techniques outlined in this book. Now if you know you have a problem with sulfites, you can avoid the obvious foods like french fries and instant potatoes. But there are so many sulfited ingredients hidden in everyday foods, it is quite likely that even a careful asthmatic will be exposed to the 3000 microgram benchmark on most days. How many soups and sauces are made with wine? What about lemon juice concentrate in salad dressings? Consider coconut in candy and cookies. Corn syrup and starch are so widespread they simply cannot be avoided. Don't forget eggs, cheese and chocolates. Caramel color is in everything that’s brown. And watch out for those pickled peppers.

How could a national sensitivity to sulfites be underestimated by doctors and health professionals far and wide? This question bothers me because most doctors are intelligent, informed and concerned. And, most everyone knows that sulfites can trigger asthma. What's not so obvious is the subtle rise in sulfites and oxides of sulfur over the past few years. All that I know is I'm 60 years old and it took me 45 years to figure out I'm highly sensitive to sulfites. Not long ago, I discovered that caramel color is a nasty source of sulfite. I doubt one person out of 10,000 knows about caramel color. In 1980, if you dropped dead at a salad bar, it was pretty obvious that sulfites were a problem. In 2000, if you feel lousy because you had a double serving of pie, who is going to suspect sulfites?

If you have asthma, you might want to look into sulfites. Sulfites could be a direct trigger or an indirect co-trigger. Ask your doctor’s opinion about reducing your intake of the oxides of sulfur as described in this book. Ask your doctor to comment on the facts and assumptions relating to asthma. Then if your doctor agrees, try to avoid sulfur preservatives. If you feel better, you will have made a great discovery. If you feel no improvement, at least you will know that sulfites are not one of your problems.