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Overcoming Inflammation

Diseases and Conditions Overcoming Inflammation

Can UV light trigger lupus flares?

July 12, 2017
Can UV light trigger lupus flares?

Now that summer is finally in full swing, I’d like to remind everyone to use broad spectrum sunscreen while enjoying the sun!  This is especially important for people living with systemic lupus erythematosus (SLE). Ultraviolet (UV) light is a known trigger of SLE flares BOTH involving the skin and major organs.  Many people also report joint pain, weakness, and headaches.  These flares can be very serious.

Although we know UV light is a trigger for SLE flares, we still don’t fully know how it happens.  This is what we do know.

  • UV light directly damages the DNA of skin cells.
  • The cells release inflammatory cytokines, most notably interleukin-1α and tumor necrosis factor-α.
  • UV light also increases interferon-α signaling. People with high levels of interferon-α signaling often develop fevers, fatigue, and low white cell count (leukopenia).  Interferon-α signaling is thought to be an important part in the development of SLE.

Take home points

So while you’re enjoying the sun remember to:

  1. Avoid the sun when UV light is strongest, between 10 AM and 3 PM. If you use IFTTT, check out this app.  You will get a notification on your phone when the UV index is high… and it’s free!
  2. Use broad spectrum UVA/UVB sunscreen.  Try to aim for a SPF higher than 30.
  3. Try wearing clothing that have vivid colors and a tight weave. The Skin Cancer Foundation has a great article regarding this topic: “What is Sun-Safe Clothing?”
  4. Wear a broad-brimmed hat when spending time in the sun.

Be safe and please leave your comments below!

References

 Fernandez D, Kirou KA. What causes lupus flares?  2016 Mar;18(3):14. doi: 10.1007/s11926-016-0562-3.

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis and treatment.

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What is the best diet for autoimmune diseases

June 21, 2017
What are some foods have anti-inflammatory properties?

In recent years there’s been a lot of talk about the autoimmune diet. But what exactly is an autoimmune diet and which foods have anti-inflammatory properties?  These are some of the most common questions my patients ask me in clinic.  Essentially, what foods help autoimmune diseases?  In certain cases, it’s pretty cut and dry.  If you have celiac disease, avoid gluten.  If you have ankylosing spondylitis, Crohn’s disease, or ulcerative colitis, try to follow the FODMAP diet.  There already exists evidence-based research that supports these interventions.

But what about other autoimmune diseases like rheumatoid arthritis, lupus, Sjogren’s syndrome?  What should you be eating if you have any of these?  Do they have their own autoimmune diet?  Should you avoid nightshades, dairy, gluten, eggs, etc.  In recent rears a myriad of “anti-inflammatory diets” have surfaced on the web.  For the most part, they are supported by little if any evidence-based research.  This is unsurprising.  Good quality research requires money.  Lot’s of money… pharma money.  It simply does not make any business sense for these companies to fund large and expensive studies that have no commercial potential.  Believe me, I am not defending big pharma, I’m simply stating reality.

What is epigenetics?

Even though we do not have great scientific evidence supporting a particular autoimmune diet or foods to prevent, cure, or lessen autoimmune diseases, it’s kind of obvious that some lifestyle practices lead to better health outcomes.  Take smoking.  People that smoke tend to get lung cancer and develop heart disease compared to those that don’t smoke.  But how does that work exactly?

Everyone is born with genes.  Some of these genes are active and some remain dormant.  Your genotype is the entire makeup of your genes.  Your phenotype is the result of how your genetic material is expressed.  For example, you may have the genes for blue eyes and brown eyes.  If the genetic material for brown eyes is dominant, you’ll have brown eyes.

This is where it gets really interesting.  Over the course of your lifetime, some of your genes are turned on and off.  This is influenced by factors like aging, the environment, and lifestyle.  Epigenetics is the study of how genes are turned on and off based on external influences.

Epigenetic changes can be good but can also cause harm.  We think that some of these changes can result in autoimmune diseases.  It’s important to remember that epigenetics is in its infancy.  Researchers still are not 100% sure how this happens, let alone, how to specifically manipulate the environment to cause favorable epigenetic change.

Autoimmune diet: what foods should I eat?

This simple answer to this question is, “I don’t know”.  One day, when researchers crack the epigenetic code, I may be able to answer this questions more accurately.  I may be able to tell you, if you follow the rheumatoid arthritis autoimmune diet, this should help control your inflammation.  Unfortunately, I am unable to say that yet.

But like I was saying at the beginning of this post, some people who adhere to certain lifestyle practices tend to be healthier.  Given we don’t really have actionable epigenetic data to guide lifestyle choices, the goal when it comes to nutrition and lifestyle is to adopt habits that have a tendency to result in overall general health to live happier, healthier, and longer.

The Blue Zones®

The Blue Zones® are 5 regions in the world where people statistically people tend to live to 100 years AND who tend to reach this age in health.  The project spawned from the National Geographic Society.  The goal was to find “hot spots of longevity” around the world.  The researchers identified 5 zones and circled them in blue ink.  These regions are as follows:

  • Ikaria, Greece
  • Okinawa, Japan
  • Ogliastra region, Sardinia
  • Loma Linda, California
  • Nicoya Peninsula, Costa Rica

One would think that there are no similarities between people living in Japan versus people in Greece.  What the researchers identified was a core list of lifestyle practices and environmental factors that shared between all the different regions.

The Power 9®

Move Naturally

People that live to 100 years don’t necessarily run marathons or go the gym.  They are always on the go and they move naturally.  For example, they tend a garden, they walk to the market, they use stairs instead of the elevator.

Purpose

People that live in the Blue Zones live with purpose.  They wake up every morning, and they know “why I wake up in the morning”.  Having a clear purpose in life can add an extra 7 years of life expectancy.

Down Shift

We all know that stress can cause inflammation.  I often see people in my clinic who’s rheumatoid arthritis was in perfect control until something really bad happened, like a divorce, job loss, or a death in the family.  Chronic stress leads to chronic inflammation.  People in the Blue Zones develop daily habits to help reduce stress.

80% Rule

The Japanese have a saying “Hara hachi bu”.  This is a mantra that Okinawans say before every meal, reminding them to stop eating when they feel about 80% full.  There is a delay between feeling full and actually being full.  When you feel 80% full, you are actually full.  So if you stop eating when you feel full, you are overeating.  People living in the Blue Zones tend to eat their largest meal at breakfast and their smallest meal at dinner.

Plant Slant

Although not all regions of the Blue Zones eat meat, their diets all mainly consists of fresh veg and beans.  Lot’s of beans: fava, soy, lentils, etc.  They eat meat very sparingly and servings are small, “about the size of a deck of cards”.

Wine @ 5

Thank goodness for this one!  People in the Blue Zones, expect for Adventists, drink alcohol moderately and regularly.  Typically, they drink 1-2 glasses of wine per day with friends and family at the end of the work day.  They found that people who drink regularly and moderately tend to live longer than those who don’t.

Belong

Almost all people who live until 100 tend to belong to some sort of faith-based community.  They found that attending a service 4 times a month can add up to 4 – 14 years of life expectancy.

Loved Ones First

People living in Blue Zones tend to live close to their families.  It’s common to have children, parents, and grandparents living under the same roof.  They also tend to commit to a life partner.

Right Tribe

People in the Blue Zones keep strong social networks.  Not only are these social strong, but they also foster healthy behaviors.  Women in Okinawa create “moais” early on in life.  These are groups of 5 friends that are completely committed to each other for life.


The true beauty in the Blue Zones Project® is that you don’t need to live in a Blue Zone to reap the benefits.  By living the Power 9® you can set yourself up to live with vitality to a ripe old age.

Conclusion

Medications certainly have made a huge difference in the prognosis of many autoimmune diseases like rheumatoid arthritis and lupus but it’s not enough.  By integrating healthy habits we can potentially turn on an and off genes that contribute to ongoing autoimmunity and inflammation.  Although we still don’t know exactly what the perfect autoimmune diet is, by adopting healthy habits set forth by the Power 9®, you can increase your odds to live a long, happy and healthy life.

Overcoming Inflammation

Tips for family and friends for people living with rheumatoid arthritis

March 15, 2017

Last week I was listening to one of my patients describe their condition in a deeply emotional and revealing way.  He honestly caught me off guard.

He said, that he woke up one day, and felt like a blob.  Like a being without joints, without tendons, ligaments or structure.  He could not walk or move.  He did not feel human anymore.

He was describing Part I of Franz Kafka’s seminal work, The Metamorphosis.  For those who have not read this novella, The Metamorphosis is the story of Gregor, a travelling salesman, who wakes one morning to discover that he has transformed into an insect-like being.  There is no rhyme or reason for his transformation.  It did not happen because he was a bad person or because of something he did.  It simply just happened.  The story deals with his attempts to adjust to his new physical state and his attempts to cling onto his humanity.  It also deals with the transforming relationships he has with various members of his family.  First how some show empathy but then quickly this empathy transforms into a sense burden and then repulsion.

Sound familiar?

When you think about it, it’s kind of depressing, especially for those who suffer from chronic diseases such as rheumatoid arthritis.  In certain cases, it’s a reflection of reality.  One wakes up one day and learns that their body will not let them to do what they used to do.  In the case of rheumatoid arthritis, you didn’t do anything to cause it.  It just happened.  It’s not like you were smoking 3 packs of cigarettes a day for 20 years and then you get diagnosed with emphysema.  That’s called playing with fire.  With RA, it just happens.

So now you find yourself not being able to do what you used to do: do your job, support your family, play with your kids.  It’s not because of a lack of will, your body simply won’t let you… not that you should give up:)  Now you become a burden to your family.  Your relationships change.

Unlike Kafka, I personally refuse to believe that these relationships will inevitably sour.  Healthy relationships with your loved ones can you grow healthier physically, emotionally, and psychologically.

The following are 8 tips to help metamorphose relationships into healthy and supportive ones.  Please share with family and friends!

 

Learn as much as you can about your loved ones disease

Knowledge is power.  It’s easier to have empathy when you have a sense of what’s going on and also what to expect.

But don’t assume you know everything.  You don’t.

No one likes a know-it all.  Don’t assume that you know what your loved one is going through or how they feel.  You can’t learn that in a textbook or from an article.  Be supportive.

Be a good listener

Sometimes people simply need vent.  Listen for cues.

Be adaptable

Life is going to change whether you like it or not.  There’s going to be good days and there’s going to be bad days.  Being rigid about your expectations is not going to get you anywhere.  Be flexible.

Don’t be overprotective

Find balance.  Although you want to help your loved one as much as you can, you also don’t want to strip them of their independence and by being overprotective.

Open communication

Be open about your emotions and thoughts.  A healthy relationship is one free of passive aggressiveness.

Join a support group

There are many support groups out there.  Let me tell you, I’ve been there.  Not for RA though.  All of a sudden the person you love and depend on, gets diagnosed with this terrible disease.  And EVERYTHING changes.  There’s nothing worse than the deep sense of loneliness that comes along.  Support groups can help overcome the isolation.  Find a support group near you!

Unconditional love

Whatever life throws at us, we will deal with it together.  I promise not to scream at you because I’m having a bad day.  I promise not to blame you for the money problems we have now.  I love you, I will support, and advocate for you no matter what conditions.  This is unconditional love.

 

I hope this has been helpful. Please leave any comments below.  I’m interested in hearing your thoughts and experiences.

 

Diseases and Conditions Overcoming Inflammation

Simple and easy ways to hydrate your skin

January 23, 2017

This past Christmas, I received probably one of the most bizarre gifts I have ever received.  A full adult-sized onesie! Let me tell you, it hasn’t really brought out the most flattering bit of my anatomy.  Last year I had lamented that my house was kind of cold in the winter and mentioned that babies had it made with their one-piece pajamas.  That being said, I decided to use my family’s superhuman memory to my advantage.  This year it was all about my dry skin and how wonderful it would be to have a paraffin wax machine.

I have to admit it though, that onesie does keep me nice and toasty at night!

While waiting for the paraffin wax machine that hopefully will be making its apparition Christmas 2017, hint-hint, I thought I’d do a little research about the topic of dry skin: anatomy, immunology, and basically how to keep it as moist as possible without that oily feeling.  People who suffer from autoimmune diseases tend to suffer from dry skin.  This really isn’t surprising.  This skin is the largest organ in the human body.  Because of its large surface area, it needs a large complex immune system.  Autoimmune diseases = inflammation and inflammation involving the skin = dryness, irritation, and itchiness.

Anatomy and immunology

The medical term for dry skin is xerosis and the term dermatitis signifies inflammation of the skin.  The skin is made up of the epidermis which is the most superficial layer followed by the dermis and then the subcutis.  These layers are made up of blood vessels, hair follicles, as well as glands.  One of the main functions of the skin is to protect your body from the outside world.  That being said, the skin contains many immune cells such as Langerhans cells, neutrophils, eosinophils, and lymphocytes.  When skin is irritated by bacteria, viruses, chemicals, the immune system kicks in to fight off the foreign invader.  With autoimmune diseases, it’s the immune system that starts to attack the skin itself.  In either case, when the immune system is activated it causes inflammation which = irritation + dryness.

There are many autoimmune diseases that affect the skin.  Some of these include scleroderma, Sjögren’s syndrome, rheumatoid arthritis, lupus, sarcoidosis, and psoriasis.

So what can you do to keep your skin moist and healthy? Drink plenty of water, limit the amount of exposure of your skin to water, protect your skin from the sun, avoid allergens, and moisturize regularly.

Avoiding irritation and dehydration

You would think that more water equals more hydration.  That may be true for ingested water, but it’s the opposite for water that makes direct contact with your skin.  For example, every healthcare worker soon learns that there is a positive correlation between the dryness of their hands with the amount of times they wash their hands per day.  Don’t get me wrong washing your hands is very important to prevent the spread of infection, but it certainly does a number to your skin.  Some things simply cannot be avoided.  That being said, if you suffer from dry skin, try to limit the amount of time you spend washing in the shower.  Make it a quick 5 min instead of a long 30 min shower.  Another tip is to use lukewarm water instead of hot water.

For people who shave, try to shave immediately after you shower.  The hair will be much more malleable at this time.  Always use a sharp razor and always shave with the line the hair grows.  These will lessen the amount of irritation caused by shaving.

This may sound obvious, but it’s really important to prevent your skin from burning.  Burnt skin = dehydration.  If you plan on being in the sun, try to stay in the shade between 11 AM and 3 PM.  The UV is at its highest during these hours.  Aim to cover up with clothing made of light-colored cotton.  Light colored clothing adds a few extra SPF points.  Broad-brimmed hats and sunglasses are your friends.  Use sunscreen liberally.  At least 15 SPF.  For people suffering from lupus, plan for a much high SPF as UV can actually trigger a full-fledged systemic flare.

What I mean by avoiding allergens means, try to avoid anything that may cause some form of allergic reaction.  Again allergic reaction = inflammation = deterioration of skin barrier function = dehydration.  Obviously, it’s impossible to avoid everything but it may be a good idea to swap perfumed household products for hypoallergenic ones: laundry detergent, softener, soap, shampoo, moisturizer etc.  Anything that directly or indirectly makes contact with your skin.  It’s important to note that even, “all natural” products can potentially contain allergens.  For example, most people aren’t allergic to Shea butter, but some are.  Learn to know your skin.

Hydrate you skin

Are you as confused as I am when it comes to moisturizers?  Which ones are good?  Which ones are bad?  What’s the difference between a lotion, cream, and an ointment?  What goes where?  How much should I apply?  How often?

It’s essential to moisturize daily particularly those suffering from dry skin conditions.  Simply put, dry skin is determined by the amount of transepidermal water loss and this in term is determined on the integrity of the skin barrier function.  The composition of the moisturizer determines whether the treatment helps skin barrier function or not.  I can’t tell you which moisturizer is better than the other, because I haven’t found any blinded head-to-head evidence-based studies addressing this topic.  If you do find one, let me know.  I’m all ears!

Moisturizers come in various forms: lotions, creams, and ointments.  Lotions are the least greasy and ointments are the greasiest.  Typically, the greasier the moisturizer, the longer it lasts.  The questions what goes where and how often and how much to apply, may actually be over-complicating the matter.  The goal is to keep the skin nice and hydrated.  When you really think about it, consistency is key.  Would you wear a thick greasy ointment on your hands all day long?  I wouldn’t because it’s uncomfortable and quite frankly not practical.  Due to my job description, I wash my hands nearing 100 times a day.  I’d rather use a cream or lotion and simply apply it more often.  The ointment might be better tolerated at night before going to bed?  If I’m comfortable, I’m more likely to wear the moisturize regularly.  How much to apply?  Apply enough so that the skin feels moist.

Like I said, there’s no need to complicate things.

One word of advice, when applying a moisturizer, try to stoke it onto the skin in the direction that the hair naturally falls.  This can prevent folliculitis.

Caution

A little bit about miracle cures.  They don’t exist.  Any product marketing itself to be a “cure for psoriasis”, is probably a product to be avoided.   A lot of these products have high doses of corticosteroids, which may initially make the skin look more hydrated and look “healthier”.  If you suffer from psoriasis, it may even clear it up.  But in the long run, regular application will cause permanent skin thinning, aging, and atrophy.  Just like food, read the ingredients on the packaging of your moisturizer.

When it comes to diet, in general beware of any diet advocating cutting out lists of foods.  For the most part, these are not founded in evidence and you actually may be doing more harm than good.  Nothing beats a clean diet and plenty of water.  What that actually means, is a matter up for debate.  For more information regarding clean eating, I recommend visiting the Blue Zone Project by Healthways.  The Blue Zone principles were derived from a National Geographic study identifying practices in cultures where people tend to live longer, i.e., greater than 100 years of age, and healthier as compared to the normal population.  When you have entire populations of people living longer and healthier over  thousands upon thousands of patient years, it makes me think they’re onto something.

Parting words

I hope you’ve found this information useful.  If you would like more information, please contact your local physician.  Love your skin, keep it nice and hydrated!

References

Dermatology Secrets Plus, 5th edition copyright 2016 by Elsevier

American Academy of Dermatology

Loden M. Effect on moisturizers on epidermal barrier function. Clin Dermatol. 2012 May-Jun;30(3):286-96.

Penzer R. Providing patients with information on caring for skin. Nurs Stand. 2008 Nov 5;23(9):49-56.

Featured Overcoming Inflammation

10 powerful life lessons to help overcome adversity

January 2, 2017

2017 is upon us and is gearing to be very interesting.  It’s going to be a year of change.  Lots of changes.  Whether for the better or for the worse remains to be determined… but I’m NOT going into any politics.  Lol!

We can’t deny that 2016 is over and it’s been a whirlwind both in the world of foreign and domestic affairs.  These events may even have affected your life in some way or another: ridiculous increase in your insurance premiums?  Your insurance company decided to not cover your medications anymore without any real justification? Maybe your health took a turn for the worse?  While we can’t control everything that happens around us, we certainly can look inwards and develop strategies to not only cope with adversity, but overcome and thrive.  Why be a victim when you could be a conqueror?

So far, I’ve been blessed with perfect health.  Living with with a chronic illness is tough.  It can devour you and unfortunately, sometimes it comes to define you.  But it doesn’t need to be that way.

I’d like to share with you a very personal story about the bravest, noblest, most compassionate, and selfless person I have ever met: Paul Feeney.  Maybe you may find some positive inspiration learning from his struggles but I secretly hope you learn most from his struggle.

Back in 2013, after fighting esophageal cancer for just shy of 2 years, my husband Paul passed away.  His passing is not the point of this post, but rather what he has to teach each one of us about adversity, courage, dignity, and the genuine love of life.

Here’s a picture of Paul doing dips at the gym.  Sorry for the poor graphics.  My phone was kind of basic and not that great back then.  But I digress.  That little pack he has around his waist, that’s chemo. More precisely fluorouracil (5-FU), and it’s pumping directly into his veins.  I believe I took this picture during his second or third month of chemotherapy with cisplatin and 5-FU.  This regimen is downright nasty.  He probably felt like shit, pardon my French, but you would never know because he would never let you know.  Some of you may know someone like this.  The eternal stoic.

After he passed away, I had to clean out his office.  In the process, I found treasure.  He never kept a diary, just thousands of random pieces of paper with incredibly insightful messages, intermixed with tax receipts, and to-do lists.  Here is a list of his 10 powerful life lessons.

 

 

Like most people’s fight with cancer, Paul’s was both brutal and bloody for his mind, body, and soul.  Despite all odds, throughout his illness he successfully continued running a business, he continued his Marine Corps exercise regimen x5 days a week, maintained an active social life, and continued being a doting son and husband.  During his struggle, he never let the disease define him.  It was something that he needed to overcome:

I have plans!

But sometimes, no matter how positive you are, no matter how proactive you are, and no matter how much you try, you simply can’t win them all.

The day before he passed, when there really was no hope, his physician walked into his room and told him there was nothing more he could do.  We had exhausted all avenues.  He had maybe two more weeks to live.  Paul calmly stood up, shook his doctor’s hand like a true gentleman and thanked him for everything he had done.

We may not choose to suffer, but we can choose how to face suffering.  Be kind, hold yourself to a higher standard, choose to be happy.  How will you face your Goliath?

Capt. Paul W. Feeney (July 23, 1963 – May 4, 2013)

Overcoming Inflammation

10 Scientifically Proven Ways to Improve Sleep Quality

December 21, 2016
There appears to be a link between poor sleep and autoimmune diseases

According to the CDC, 50-70 million Americans suffer from a sleep disorder.  That’s a lot of people!  Insomnia can present in many different ways. Some of these can include daytime sleepiness, irritability, low concentration, headache, depression, and even joint pain.

Needless to say, a human being cannot live or function optimally without a good night’s rest.  This is fact.  Can you remember how you felt the day after a sleepless night?  I can: grumpy, achy, brain fog, demotivated, utterly tired.  Now imagine that over a period of months or years.  That I don’t want to imagine.

If you don’t sleep well, you don’t feel well, let alone heal well.  Interestingly a recent claims-based study found that there was an increased risk of autoimmune diseases in people suffering from chronic insomnia.  It’s important to note that this does not imply causality, but rather that there may a link between insomnia and autoimmune diseases.

How to improve sleep quality?

Like any scientist, I like to back up my claims with objective data.  As should you by the way.  Think for yourself!  I’ve included my references for you to read and analyze at your leisure.

If you want to continue learning more about alternative therapies to help ease some of the symptoms that your autoimmune disease may we causing or worsening, you may be interested in learning more about acupuncture or turmeric?

References

Ong JC, et al. A randomized controlled trial of mindfulness meditation for chronic insomnia. Sleep. 2014 Sep 1; 37(9): 1553–1563.

Narishige S, et al. Effects of caffeine on circadian phase, amplitude and period evaluated in cells in vitro and peripheral organs in vivo in PER2::LUCIFERSE mice. Br J Pharmacol. 2014 Dec;171(24):5858-69.

Crispim CA, et al. Relationship between food intake and sleep pattern in healthy individuals. J Clin Sleep Med. 2011 Dec 15;7(6):659-64.

Carter B, et al. Association between portable screen-based media device access or use and sleep outcomes: a systematic review and meta-analysis. JAMA Pediatr. 2016 Dec 1;170(12):1202-1208.

Ding F, et al. Changes in the composition of brain interstitial ions control the sleep wake cycle. Science. 2016 Apr 29;352(6285):550-5.

Gooley JJ, et al. Exposure to room light before bedtime suppresses melatonin onset and shortens melatonin duration in humans. J Clin Endocrinol Metab. 2011 Mar; 96(3): E463–E472.

Sleep Cycle Alarm Clock: https://www.sleepcycle.com/

Viola AU, et al. Dawn simulation light: a potential cardiac events protector. Sleep Med. 2015 Apr;16(4):457-61.

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