Elaine Moore's Blog
Posted by Elaine Moore
Recent studies show that people diagnosed with psoriasis may be at greater risk for developing heart disease. In patients with severe psoriasis who are younger than 50 years old, the risk is comparable to that seen in diabetes. In patients of all ages with psoriasis the risk for heart disease was higher than that seen in the general population, but in younger people with severe disease the risk was significantly higher.
One recent study conducted at the University of Pennsylvania School of Medicine confirmed earlier studies showing this link while controlling for age, gender, smoking, elevated cholesterol, and other risk factors. Several studies show that patients with psoriasis often have key components seen in metabolic syndrome, including hypertension, obesity, elevated lipids, and insulin resistance. Furthermore, the inflammatory process in psoriasis is similar to the inflammatory process that occurs in atherosclerosis, a condition commonly referred to as hardening of the arteries. Both conditions are associated with elevated levels of the inflammatory blood marker C-Reactive Protein (CRP).
Inflammation as the Culprit
Earlier studies from the Karolina Institute have shown a higher risk for heart disease in patients with rheumatoid arthritis and systemic lupus erythematosus. The common link, researchers believe, is the underlying inflammation. Inflammation is the immune system's response to injury in infection. In patients with psoriasis and other autoimmune disorders, the immune system persists in launching this inflammatory response. Chronic inflammation allows cholesterol and other cellular debris to build up forming plaques in the arteries.
Studies show that patients with psoriasis, particularly men, use alcohol and smoking as a form of self-medication to reduce the emotional consequences of psoriasis. Studies show an increased mortality in patients with psoriasis, attributed to heavy drinking. Smoking has also been cited as a major risk factor in psoriasis, particularly for pustular psoriasis. Severe psoriasis is also known to cause folate deficiency, which is linked to high levels of homocysteine. Elevated homocysteine levels are an additional risk factor for heart disease.
The fact that psoriasis is linked to high risk for heart disease suggests that psoriasis is a systemic inflammatory disorder. Researchers at Mayo Clinic report that the benefit of these studies is that younger patients can now monitor their other factors for heart disease and reduce known risk factors. Whether conventional treatments for psoriasis can reduce this increased risk of heart disease is not yet known.
Fish Oil as a Solution
Fish oil supplements have been suggested as a treatment for persistent inflammation. Fish oil supplements are now FDA approved for the treatment of lipid disorders, and available in prescription form as well as over the counter preparations. The EPA and DHA omega-3 components of fish work like aspirin, preventing platelets from adhering together and promoting clot formation. In this way, like aspirin, fish oils reduce the risk of heart attack
Resources
Rick Ansorge, Psoriasis May Up Risk of Heart Attack, WebMD Health, Oct 10, 2006, Medscape News Article
Evidence that People with Psoriasis Have Greater Risk For Developing Heart Disease Than General Population, Dermatology News, November 13, 2006.
Fishing for Answers, Foundations of Wellness, UC Berkeley Wellness Letter.
Moira Petty, Daily Mail, Psoriasis linked to heart disease, October 25, 2005.
Posted by Elaine Moore
The U.S. Food and Drug Administration has issued a new warning for Rituxan after the death of two patients with systemic lupus erythematosus (SLE) who were being treated with Rituxan. The cause of death was a brain infection known as progressive multifocal leukoencephalopathy or PML, which had previously been associated with Rituxan in people who were immunosuppressed. Immunosuppression, a condition of decreased immune function, is seen in people with acquired immune deficiency syndrome (AIDS) and in people being treated with immunosuppressant drugs such as methotrexate.
Rituxan is the brand name for rituximab, a monoclonal antibody, produced by Biogen Idec and Genetech. Rituximab was first introduced as a treatment for non-Hodgkin's leukemia and B-cell leukemia. It is also used for rheumatoid arthritis and off label for several autoimmune conditions including systemic lupus. Rituxan is usually used in combination with another immunosuppressant medication.
Rituximab decreases the production of specific white blood cells associated with antibody production. Besides interfering with the production of autoantibodies, Rituximab interferes with the immune system's ability to fight against infection. In patients who are immunosuppressed Rituximab opens the doors to opportunistic infections. Opportunistic infections are infections caused by organisms such as yeast that are not usually the cause of serious disease.
Most cases of PML have traditionally occurred in patients with AIDS. Opportunistic infections are one of the leading causes of death in patients with AIDS as their immune systems become too weak to fight.
In a Marketwatch alert, it was reported that on December 19, 2006 Biogen Idec and Genetech company officials advised physicians to watch for signs of PML in their patients on Rituximab. Early symptoms of PML include problems with vision, coordination or balance.
Other warnings issued for rituximab previously include warnings for symptoms of oral ulceration and an increased risk of developing viral infections including hepatitis. In addition, Rituxan has been reported to cause bowel and gastrointestinal disease.
In an FDA alert on Rituxan issued on December 18, 2006 officials advised doctors to discuss the chances of PML with their patients on Rituxan, cautioning that there is no known treatment available for PML. The FDA also clarified that Rituximab is not an approved medication for patients with systemic lupus. The risk of developing PML can occur as long as one year after the last injection of Rituxan, making follow-up with patients previously treated critically important.
Although rituximab is currently being studied in clinical trials for patients with SLE, the two lupus patients who died were not enrolled in clinical trials.
Resources:
Clinical Trials at www.clinicaltrials.gov
Marketwatch
Reuters Health News
Posted by Elaine Moore
In the 6th Century B.C. Hippocrates wrote that "For this is the great error of our day that the physicians separate the soul from the body." Today, despite scientific advances showing how our emotions and spirit affect our health, some physicians refuse to make the connection. This despite the fact that in 1975, Dr. Robert Ader, Director of the Division of Behavioral and Psychosocial Medicine at the University of Rochester in New York, first reported that our immune system, nervous system, and endocrine system work together, each system influencing the other systems. The study of these complex interactions was originally termed psychoneuroimmunology or PNI although today it is more commonly referred to as the mind-body connection. By 1980, the early studies of Ader were reproduced and confirmed by researchers at Harvard University, and today PNI is taught at most leading medical schools.
Immune System Influences
The early studies of Dr. Ader showed that the immune system can be conditioned. In one early experiment consisted of feeding mice with saccharin while simultaneously injecting a second drug that caused upset stomach. By association, the mice learned to avoid the saccharin. An additional side affect of the drug used was that it suppressed the immune system. When the experiment was repeated without the drug to reverse the aversion Dr. Ader found a high proportion of the mice formally injected died when receiving saccharin alone because of immune suppression.
Dr. Ader hypothesized that the conditioning had been so successful that saccharin alone suppressed the immune system enough to kill the mice. It is possible then, that when there is stress on the organism, mental or physical, that there is a corresponding link between the two systems. That is, if a person is depressed, this state can be interpreted by the body, and, in response, the person experiences lethargy and other corresponding ailments. Conversely, if the body is diagnosed as ailing from a serious disease, for instance multiple sclerosis, a negative mental state may ensue. By conditioning the immune system behaves accordingly. Providing the patient with some feeling of control over their circumstances may create a positive outlook and attitude.
Psychoneuroimmunology then is the scientific field of study investigating the link between bi-directional communications among the nervous system, the endocrine (hormone) system, and the immune system and the implications of these linkages for physical health.
In similar studies at Harvard University, Dr. Joan Borysenko described a study on rabbits that were treated with a potent cancer-inducing agent. Although all of the rabbits in the upper cages developed the expected cancer, the rabbits in the lower cages remained free of cancer. Upon investigating, the researchers learned that the laboratory assistant who administered the medications consistently petted the rabbits in the lower cages since they were easier to reach. Their emotional well being caused their immune system to fight the effects of the administered medication, and they remained healthy.
Stress and Emotions in Autoimmune Disease
Stress is a well-known trigger of autoimmune disease. The flares and exacerbations that are characteristic of autoimmune disorders correspond to periods of heightened stress. In studies of patients with Graves' disease, the stress associated with bereavement is a significant disease trigger.
Candace Pert, in her book on the mind-body connection explains how hormones produced during times of stress affect our emotions, and both hormonal and emotional changes produce peptides that influence immune function. In her work on Metaphysics, Louise Hay explained how specific emotions induce specific disease states and how disease states can be reversed through changes in attitude that influence emotions.
Resources:
Louise L. Hay, Heal Your Body, Carlsbad, CA: Hay House, 1982.
Elaine Moore, Autoimmune Diseases and Their Environmental Triggers, Jefferson, NC: McFarland and Company, 2002.
Candace Pert, Molecules of Emotion, The Science Behind Mind-Body Medicine, New York: Simon & Schuster, 1997.
Posted by Elaine Moore
The winter holidays are generally considered times of stress. Besides dealing with icy roads, aching joints, and car batteries that refuse to stir, we may feel as obligated as Santa Claus to ensure the best Christmas ever for our loved ones. However, even with the best intentions, we set ourselves up for failure and harm our health when our visions of a perfect Christmas stray from reality. The winter holidays don't have to be a stressful marathon that leaves us disappointed and exhausted. We can find ways to make holiday stress work for us.
Consider that stress in itself isn't necessarily harmful. It's how we deal with stress that causes the problem. As evidenced by the stress-induced fight or flight response, stress causes us to react. If all goes well, we're pleased with the outcome and so are our immune system's cells.
Our reaction to stress is an opportunity to be creative. Even if we don't have time to bake or shop or decorate and send cards, we can enjoy the season with minimal fuss. And given that the winter holidays are upon us every 365 days, we have at least a fair warning and time to plan. An article I wrote several years ago, Hope for the Holidays, describes the holiday anxiety faced by patients with Graves' disease and offers suggestions for coping. These tips apply to anyone with a chronic autoimmune condition.
Other tips I'll offer from my 58 years of wisdom:
1) We can't please them all. Even if we had all the money in the world, we wouldn't be able to find the perfect present for everyone on our list. I've seen the most genuine smiles of delight from stocking stuffers I've given and the most passive glances from presents I struggled to find. Tip: don't try too hard.
2) We don't need to accept every invitation we receive. If there's a function we truly want to attend, we should make the effort to go. But there's no point in wearing ourselves out because we feel obligated to show up somewhere.
3) Spend only what you can afford regardless if you're shopping for presents, a New Year's dress, or holiday meals. There's no contest or prize given for the person who racks up the most debt.
4) Make it a family affair. Spouses, children, parents, and friends are all willing to help us if we know how and when to ask. Today I commented on how I needed an elf or two and got the response I needed.
5) Take advantage of the electronic age. Shop online watching for email announcements of free shipping and other discounts. Who wouldn't want a Honey Baked Ham with the fixings arriving at their door? Take advantage of Gift Cards especially ones that give a discount when you buy the card and when it's used. Think Eastbay.com for the athletes on your list.
6) Limit shopping excursions. Only shop for 1-2 items. Enjoy the decorations and watch the crowds. Use the opportunity of an outing to have lunch out and don't forget to treat yourself. When you get home, take a lavender bubble bath and unwind with a dark chocolate fix.
7) Enjoy the season. Be grateful for the opportunity to spend time with your loved ones. Relax and don't fret over the mounds of crumbs and wrapping paper littering the floor. You can always clean next year.
Posted by Elaine Moore
Practitioners of energy medicine believe that illness results from disturbances of the body's energy field. According to the National Center for Complementary and Alternative Medicine (NCCAM) energy fields of two types are targeted in energy medicine: 1) those which are veritable and can be measured and those which are 1) putative, which have yet to be measured. Some therapists are believed to emit or transmit the vital energy or external qi to a recipient in an effort to restore health.
Veritable energies employ mechanical vibrations such as sound and electromagnetic forces, including visible light, magnetism, monochromatic radiation (such as laser beams), and rays from other parts of the electromagnetic spectrum (such as bright light therapy). Veritable energies involve the use of specific, measurable wavelengths and frequencies to treat patients. Consequently, treatment methods employ specific protocols with measurable therapies.
In contrast to veritable energies, putative energy fields, which are called biofields, have defied measurement by reproducible methods. Therapies involving putative energy fields stem from the notion that human beings have an inherent subtle form of energy. This vital form of energy, which is known by many names including qi, homeopathic resonance, odic force and mana, is thought to flow through the human body. However, this form of energy, which has been photographed as an aura and sensed by certain practitioners, cannot be scientifically measured.
Examples of energy medicine involving putative energy fields include: the Japanese treatments of Reiki and Johrei; the Chinese practice of qi gong; healing touch or the laying of hands to correct energy; and intercessory prayer, in which a person intercedes energy correction through prayer on behalf of another. Because the provision of therapy and the effects of therapy cannot be measured, they are among the most controversial of the complementary and alternative therapies. But because of their reported benefits, these treatments are being investigated at some academic medical centers.
Current Research
For measuring veritable energy therapies, many treatments are available, including magnetic resonance imaging, ultraviolet light therapy for psoriasis and vitiligo, laser keratoplasty, and radiation therapy. Magnetic therapy is used in vasculitis to dilate constricted vessels and to dilate vessels that are constricted. In addition, low-power millimeter wave irradiation is widely used in Europe to treat conditions ranging from skin disorders to cancers and cardiovascular diseases and psychiatric illnesses. Sound energy (vibrational, sound, and frequency therapy) is used to lower blood pressure, reduce pain, alter certain biochemicals, and reduce anxiety.
Of the putative therapies, acupuncture is the most widely used therapy to promote qi flow along the meridians. Studies show its effectiveness in reducing certain forms of pain although the measurement of energy has remained elusive.
Qi gong, a movement therapy reported to restore health, cannot be quantitatively measured and studies showing improvement are based on anecdotal evidence alone. Homeopathy and therapeutic touch are also reported to offer benefits based on anecdotal evidence alone.
Energy fields have been measured putatively using Kirlian photography, aura imaging, and gas discharge visualization. However, there is no certainty regarding what exactly is being measured. Early reports showed a marked decrease in gamma radiation following energy therapies and these studies have recently been confirmed. The hypothesis here is that the body's primary gamma emitter, potassium-40, represents a self-regulator of energy.
But even though energy medicine employs therapies defying measurement that cause benefits, which cannot be quantitatively assessed, the anecdotal reports of patients worldwide show that these therapies offer much more than a placebo effect. The importance of energy medicine in both acute and chronic diseases cannot be denied. Fortunately for autoimmune disease patients, the National Center for Complementary and Alternative Medicine is committed to exploring these benefits.
Resources:
Energy Medicine: An Overview, National Center for Complementary and Alternative Medicine, http://nccam.nih.gov/health/backgrpimds/energymed.htm, accessed on November 28, 2006.
The Energy Medicine Institute, www.energymed.org
