Tag: diet

04 Sep 2018

Eat to Calm Psoriasis

Most people with psoriasis will have some degree of symptoms for life. But this doesn’t mean that improvement can’t happen. Medications help keep this skin disease under control and combining medication with certain dietary choices can also have a positive effect on both psoriasis and psoriatic arthritis (which is a joint condition related to the skin disease).

The Medical Board of the National Psoriasis Foundation recently reviewed the current body of scientific research so they could share the latest understandings about how diet affects psoriasis and psoriatic arthritis. Their review included 55 studies – which covered more than 77,000 people both with and without psoriasis.

The biggest take-away from this National Psoriasis Foundation project relates to overweight or obese patients with psoriasis. It may not be the most popular news to hear, but the evidence shows that a low-calorie diet with the goal of losing weight leads to significant improvements in the severity of psoriasis symptoms, as well as (obviously) weight loss and an improved “dermatology quality of life.” Losing weight improves both skin and joint symptoms of psoriasis, which is why this dietary change earned the Medical Board’s strongest recommendation.

People with psoriasis are known to have a higher risk of also developing celiac disease, which is why gluten-free diets tend to be popular with psoriasis sufferers. According to this Medical Board, gluten-free diets have shown some benefit, but only in patients who test positive (based on a blood test) for gluten sensitivity. In these situations, a three-month trial of going gluten-free can make sense.

In terms of dietary supplements, the strongest evidence emerged for vitamin D supplements, but this recommendation was geared specifically to overweight/obese patients with psoriatic arthritis.

One final thing that’s important to keep in mind: all of these dietary changes are recommended to be done in combination with a medication plan of care – not in place of one.

Sources

Ford AR, Siegel M, Bagel J, et al. Dietary recommendations for adults with psoriasis or psoriatic arthritis from the medical board of the National Psoriasis Foundation: A systemic review. JAMA Dermatol 2018;154(8):934-50.

20 Mar 2018

Hepatitis C and Diabetes: A Complicated Relationship

Guest blog by: Erica Yelton, Pharm.D., CSP, Pharmacy Center Manager, BioPlus Specialty Pharmacy

Hepatitis C and diabetes are both prevalent, global diseases with long-term implications in terms of morbidity and mortality. The World Health Organization reports that 170 million people are infected with hepatitis C and 347 million people suffer with diabetes. Most studies show that patients with hepatitis C are more susceptible to developing type 2 diabetes. It is estimated that up to 33% of chronic hepatitis C patients have type 2 diabetes. The connection between these diseases is seen in both developed and developing countries. The central component of developing insulin resistance is the intense inflammatory response to the hepatitis C virus (HCV) which disrupts the insulin signaling pathway. Also, inflammation causes pro-inflammatory cytokines to be released causing damage to beta cells. Beta cells are the producers of insulin in response to glucose. Studies have shown that HCV can directly and indirectly induce beta cell dysfunction.

On the reverse side, patients with type 2 diabetes are at a higher risk for complications from HCV. Patients with HCV and insulin resistance have been shown to have significantly worse outcomes. Some of these include decreased SVR rate, increased progression of fibrosis and cirrhosis, and increased risk of hepatocellular carcinoma. When insulin is increased, which happens in those with insulin resistance, it stimulates hepatic stellate cells which produce nonfunctional matrix and scarring, AKA fibrosis. This occurs in a dose dependent fashion. Insulin resistance also causes increased release of fatty acids from adipose and increased lipid deposition both of which are associated with fibrosis. Patients with diabetes are also at an increased risk for various malignancies including hepatocellular carcinoma. Insulin, insulin-like growth factor, and chronic inflammation have all been implicated in carcinogenesis.

To further complicate the scenario, interferon, which was once the mainstay treatment for HCV, is now known to cause type 1 diabetes! Interferon is a known potent immunomodulator and can contribute to autoimmunity. In most cases studied of patients who developed type 1 diabetes, the onset occurred during or shortly after treatment with interferon. To date, there are greater than 45 known cases. It is important to suspect type 1 diabetes in patients who present with polydipsia and polyuria after treatment with interferon. Since treatment regimens now steer away from interferon, it may be that the rate of type 1 diabetes as a complication of treatment decreases.

On one hand, HCV triggers diabetes and on the other hand, diabetes worsens hepatitis C outcomes. It is recommended to screen for diabetes in all HCV-infected patient regardless of age or medical history and especially important in patients with known autoimmune conditions. The complicated relationship between these two disease states will have to be addressed until hepatitis C is eradicated and even then, the lasting effects of complications will still have to be dealt with.

Source: Hammerstad SS, Grock SF, Lee HJ, et al. Diabetes and hepatitis C: a two-way association. Frontiers Endocrin 2015;14(6):134.

27 Feb 2018

Rheumatoid Arthritis: What Should I Eat?

When it comes to rheumatoid arthritis, the foods one eats or avoids can actually affect the symptoms of this autoimmune disease. Dietary interventions can be a useful compliment to pharmacological treatment of rheumatoid arthritis. What it mostly comes down to are certain foods that either promote or discourage inflammation.

Overall, a type of diet known as the “Mediterranean diet” focuses on many of the protective foods while eschewing the problematic foods. Several human studies have documented rheumatoid arthritis symptom improvement, in terms of pain, disease activity, and daily function, when patients transition to a Mediterranean diet.

In addition to the Mediterranean diet, other dietary factors have been either lauded or implicated in rheumatoid arthritis progression and symptoms. Here is a summary of those dietary factors:

Choose These Foods   

Whole grain cereals

Fruits

Oily fish

Plant-based oils (olive oil)

Walnuts

Leafy greens

Legumes

Spices (turmeric, ginger)

Probiotic yogurt

Green tea

 

Avoid These Foods

Meat

Butter

All animal products

Processed foods

Salty foods

Sugar

Saturated fats

 

Sources

Forsyth C, Kouvari M, D’Cunha NM, et al. The effects of the Mediterranean diet on rheumatoid arthritis prevention and treatment: a systematic review of human prospective studies. Rheumatol Int December 18, 2017 doi: 10.1007/s00296-017-3912-1.

Khanna S, Jaiswal KS, Gupta B. Managing rheumatoid arthritis with dietary interventions. Front Nutr 2017;4:52.