Gluten Free lifestyle

Celiac and Psoriasis
Since both celiac disease and psoriasis are conditions which affect the auto-immune system, research seeking connections between the two has recently increased. A 2004 article in Psoriasis Advance, a magazine published by the National Psoriasis Foundation, conducted an interview with Gerd Michaelsson, M.D., Ph.D, who in 1993 preformed a study which found that some patients with psoriasis also had one of the markers of celiac disease; increased antibodies to gliadin. Dr Michaelsson stressed that "most patients with psoriasis are not gluten intolerant. However, there is a subgroup with silent celiac disease/gluten intolerance and it is important to identify these patients, as there is a chance to considerably improve the skin lesions on the gluten-free diet (GFD). In some patients there may be a total or nearly total clearance on the diet. When gluten is reintroduced there is a flare up of the psoriasis." Dr. Michaelsson thinks that it is possible that some celiac sufferers may be predisposed to psoriasis, but have not had any problems since they adhere to a strict gluten-free diet.

An article in the April 2007 issue of World Journal of Gastroenterology, by L Abenavoli, L Leggio, G Gasbarrini, G Addolorato, seems to corroborate Dr. Michalessons research. Psoriasis patients who tested positive for the markers that indicate celiac and were put on a GFD. Researchers noticed "thirty of 33 patients strictly complied with GFD, have showed a significant decrease of psoriatic lesions." Celiac is a systemic disease, and not one that is isolated simply to the digestive system. The link between psoriasis is some people is clearly tied to a gluten-sensitive enteropathy (pathology [disease] of the intestine). While the cause for psoriasis still remains unknown, and may in fact be the result of numerous factors, celiac is a genetic condition.

The Psoriasis foundation quotes yet another researcher, Dr. Kruger who thinks that the link might just be odds "simple math dictates that it would be surprising if there weren't some people with both diseases." Indeed," Dr. Krueger says, "there is a certain small percentage of people in the general population with celiac disease, and a certain small percentage of people in the general population with psoriasis, so one should not be surprised to find a significant number of people who have both. Notwithstanding, many psoriatics go into remission when adhering to a GFD.

For many, the link between celiac and psoriasis is common sense. Digestive specialist Elizabeth Lispki, Ph.D., CCN asserts in her book Digestive Wellness, that diet is the cause of most auto-immune afflictions ranging from psoriasis to colitis. Dr. John O.A. Pagano and Deirdre Earls, RD, psoriasis specialists, believe that changing what we eat can help to alleviate psoriasis outbreaks.

At DermaHarmony we offer "Your Healing Diet, a Quick Guide to Reversing Psoriasis and Chronic Diseases with Healing Foods" by Deidre Earls RD, LD, an informative book which clearly outlines rules for an effective healing diet, to our clients. Though these diets don't rule out wheat completely, they suggest it be consumed occasionally in whole grain rather than processed form. All stress the importance of wheat avoidance for celiac sufferers. The consensus among these authors seems to be "healthy gut, healthy skin."

Since both celiac disease and psoriasis are conditions which affect the auto-immune system, research seeking connections between the two has recently increased. A 2004 article in Psoriasis Advance, a magazine published by the National Psoriasis Foundation, conducted an interview with Gerd Michaelsson, M.D., Ph.D, who in 1993 preformed a study which found that some patients with psoriasis also had one of the markers of celiac disease; increased antibodies to gliadin. Dr Michaelsson stressed that "most patients with psoriasis are not gluten intolerant. However, there is a subgroup with silent celiac disease/gluten intolerance and it is important to identify these patients, as there is a chance to considerably improve the skin lesions on the gluten-free diet (GFD). In some patients there may be a total or nearly total clearance on the diet. When gluten is reintroduced there is a flare up of the psoriasis." Dr. Michaelsson thinks that it is possible that some celiac sufferers may be predisposed to psoriasis, but have not had any problems since they adhere to a strict gluten-free diet.

An article in the April 2007 issue of World Journal of Gastroenterology, by L Abenavoli, L Leggio, G Gasbarrini, G Addolorato, seems to corroborate Dr. Michalessons research. Psoriasis patients who tested positive for the markers that indicate celiac and were put on a GFD. Researchers noticed "thirty of 33 patients strictly complied with GFD, have showed a significant decrease of psoriatic lesions." Celiac is a systemic disease, and not one that is isolated simply to the digestive system. The link between psoriasis is some people is clearly tied to a gluten-sensitive enteropathy (pathology [disease] of the intestine). While the cause for psoriasis still remains unknown, and may in fact be the result of numerous factors, celiac is a genetic condition.

The Psoriasis foundation quotes yet another researcher, Dr. Kruger who thinks that the link might just be odds "simple math dictates that it would be surprising if there weren't some people with both diseases." Indeed," Dr. Krueger says, "there is a certain small percentage of people in the general population with celiac disease, and a certain small percentage of people in the general population with psoriasis, so one should not be surprised to find a significant number of people who have both. Notwithstanding, many psoriatics go into remission when adhering to a GFD.

For many, the link between celiac and psoriasis is common sense. Digestive specialist Elizabeth Lispki, Ph.D., CCN asserts in her book Digestive Wellness, that diet is the cause of most auto-immune afflictions ranging from psoriasis to colitis. Dr. John O.A. Pagano and Deirdre Earls, RD, psoriasis specialists, believe that changing what we eat can help to alleviate psoriasis outbreaks.

At DermaHarmony we offer "Your Healing Diet, a Quick Guide to Reversing Psoriasis and Chronic Diseases with Healing Foods" by Deidre Earls RD, LD, an informative book which clearly outlines rules for an effective healing diet, to our clients. Though these diets don't rule out wheat completely, they suggest it be consumed occasionally in whole grain rather than processed form. All stress the importance of wheat avoidance for celiac sufferers. The consensus among these authors seems to be "healthy gut, healthy skin."

One study conducted by Addolorato et al., reported that depression was present in a higher percentage of celiac patients. They found that one year of gluten-free diet failed significantly to affect depressive symptoms. The presence of depression after introduction of the gluten-free diet could be related to the reduction in quality of life in celiac patients. The non-regression of depression after introducing the diet could suggest that these patients need psychological support.
Another study found that celiac disease increased a patient's risk of subsequent depression. Moreover, patients with celiac disease were 1.8 times as likely to develop subsequent depression as those without the gastrointestinal disorder. Also, prior depression increased the risk of celiac disease at odds ratios of 2.3. The investigators suggested, in the Journal of Affective Disorders, that this increased risk might be due to increased screening for the condition among patients with mood disorder compared to healthy individuals.
Ludvigsson and colleagues suggested that the positive association between celiac disease and subsequent depression might be due to "malnutrition or active bowel inflammation in individuals with celiac disease." For example, folate deficiency is implicated in both celiac disease and depression. The team noted that red cell folate levels were significantly lower in people with depression than those with bipolar disorder, potentially explaining why celiac disease is associated with subsequent depression but not bipolar disorder. Tryptophan levels, which were reduced in patients with celiac disease and those with depression, might also explain the association between the conditions.
According to Mayo Clinic psychiatrist Daniel Hall-Flavin, M.D., doctors have long known of the relationship between low levels of vitamin B-12 and depression. Vitamin B-12 and other B vitamins, such as folate, play a role in the production of certain neurotransmitters, which are important in regulating mood and other brain functions. However, it is less clear whether vitamin B-12 deficiency may be the cause or the result of depression. Poor nutrition is one cause of vitamin B-12 deficiency. But poor nutrition may also be a consequence of depression. People who are depressed may lose interest in eating or make less healthy food choices, which may lead to vitamin B-12 deficiency.
Some studies attribute the relationship between celiac disease and depression to the psychological weight of having a chronic disease with a restrictive diet, sudden lifestyle changes or dietary compliance. Moreover, poor absorption of vitamins and minerals can make the celiac disease patient feel sick and depression can be a side effect of not having an adequate balance of nutrients. All these factors can affect mood and emotions. For some patients following a strict gluten-free diet is sufficient, while for others, counseling, psychological support and pharmacological treatment is helpful.

Causes of Depression
A combination of genetic, psychological, and environmental factors can cause depression. The cells of the brain, also known as neurons, communicate with each other using special chemical compounds called "neurotransmitters." When someone is depressed, there is a chemical imbalance in the neurotransmitters. Since the brain controls the whole body, people with depression may also have aches and pains that cannot be linked to any other condition. The direct causes of the illness are unclear, however it is known that body chemistry can bring on a depressive disorder, due to experiencing a traumatic event, hormonal changes, altered health habits, the presence of another illness or substance abuse.

Types of Depression

Major depressive disorder: People who have a major depressive disorder have had at least one major depressive episode (five or more symptoms for at least a two-week period). For some people, this disorder is recurrent, which means they may experience episodes once a month, once a year or several times throughout their lives.
Dysthymia: A low-level state of depressed mood that last for more than two years in adults (or one year in children) and a person has not been symptom-free for more than two months at a time. The depressed state of dysthymia is not as severe as with major depression, but can be just as disabling.
Postpartum depression is a type of depression that affects 10-15% of all new mothers.
A particular form of depression called seasonal affective disorder (SAD) is caused by seasonal shifts in daylight hours.

What are the symptoms of depression?

Prolonged sadness or unexplained crying
Significant changes in appetite and sleep patterns
Irritability, anger, worry, agitation, anxiety
Indifference
Loss of energy, persistent lethargy
Feelings of guilt, worthlessness
Inability to concentrate, indecisiveness
Inability to take pleasure in former interests, social withdrawal
Unexplained aches and pains
Thoughts of death or suicide
Treatment
When talking to your doctor about depression, keep in mind that it's important for him or her to address any underlying physical conditions - such as vitamin B-12 deficiency, thyroid disease or certain types of anemia - that may be contributing to depression. Treatment of these underlying conditions may improve depression. However, if depression persists after successful treatment of the underlying condition, your doctor may recommend treatment that specifically targets your depression, such as antidepressants or psychotherapy.

Indication for biopsy of the duodenum

Biopsy may be performed because of positive serologic tests. Alternatively a biopsy may be performed because of the recognition of abnormalities at endoscopy suggestive of celiac disease when endoscopy is performed for a reason such as esophageal reflux or dyspepsia . In one series, unsuspected celiac disease discovered by biopsy during EGD for another indication accounted for 8% of new diagnoses in the 1990's . However an argument can be made for the routine biopsy of the duodenum during endoscopy performed for any reason, irrespective of the appearance of the duodenum .

Endoscopic appearance in celiac disease

Characteristic changes in the appearance of the duodenum on endoscopy are suggestive of celiac disease. The normal duodenal appearance should include at least three normal folds per endoscopic field.

Individuals with celiac disease -- a common digestive problem in which the body cannot breakdown and absorb a protein found in wheat -- are at significantly increased risk for developing thyroid disorders, including hypothyroidism, hyperthyroidism and thyroiditis, investigators in Sweden have found.

The thyroid is a butterfly-shaped gland in the neck that produces hormones that regulate the body's metabolism. In hypothyroidism, the gland is underactive, causing symptoms such as fatigue, sensitivity to cold, dry skin and weight gain.

In hyperthyroidism, the gland is overactive, causing symptoms such as excessive sweating, heat intolerance, and nervousness. However, in mild cases of hypo- or hyperthyroidism no symptoms are present. Thyroiditis describes inflammation of the thyroid gland.

Using data from Swedish national registers, researchers led by Dr. Peter Elfstrom at Orebro University Hospital, studied the long-term risk of thyroid disease in more than 14,000 individuals diagnosed with celiac disease between 1964 and 2003 and some 68,000 age- and gender-matched control subjects without celiac disease.

They found that people with celiac disease had a greater than fourfold increased risk of being diagnosed with hypothyroidism, a threefold increased risk of suffering hyperthyroidism, and a 3.6-fold increased risk of developing thyroiditis.

The reverse was also true, with the same level of statistical significance, for an increased risk of celiac disease in people with established hypothyroidism, hyperthyroidism and thyroiditis.

"The association was seen in all strata (males, females, children, and adults)," the team notes in the Journal of Clinical Endocrinology and Metabolism, "and did not vanish after adjustment for potential confounders including the presence of diabetes mellitus."

"The positive association between celiac disease and thyroid disease may be due to shared genetic or immunological traits," the researchers say.

SOURCE: Journal of Clinical Endocrinology and Metabolism, October 2008.