Saturday, April 21, 2012

Autoimmune disease "relatives" and a little help from a friend

Ever wonder if autoimmune disease comes in "clusters" or how it relates to inflammation? Or what about comorbidities (ugly word for "things that go along with or affect your disease)?  Or how common is this stuff, really?

Well,  I was reading an online CME (continuing medical education) activity on psoriasis and rheumatoid arthritis tonight and was struck by a few things. I thought I'd share a couple here.  And yes, there is something about celiac too!

First, psoriasis affects about 2% of the population in the US. It seems like more than that to me but I work in rheumatology so my view is a bit skewed.  The inservice I read said that about 70% of people are undertreated and only receive topical treatment for the disease.  Moderate to severe disease is related to an increased risk of cardiovascular disease and metabolic disorders.  There is also a relationship between psoriasis and an increased risk of lymphoma, squamous cell skin cancer, Crohn's disease, multiple sclerosis and Type 2 diabetes.

The same mechanism for the development of psoriatic plaques (the scale-y stuff you see on someone's skin who has psoriasis) is also responsible for the development of atherosclerosis. T-cells in the lymph nodes travel to and adhere to blood vessels and produce chemicals called cytokines and chemokines that induce inflammation.  This results in plaque formation. Hmm. So inflammation=atherosclerotic plaques building up in your arteries contributing to cardiovascular disease. Well, what about cholesterol? (I think I'll talk about that elsewhere, but think about it.)

Next, rheumatoid arthritis (RA) affects approximately 1% of the US population. It too carries an increased risk of lymphoma.  Both are aggravated by stress, smoking and obesity. RA is also  inflammatory in nature and carries increased risk of cardiovascular disease. 

So, how many people do you know with RA? And how many people do you know with psoriasis? Approximately 1% of the US population is believed to have celiac disease. That's the SAME AS RA and half the rate of psoriasis. How many people do you know with a diagnosis of celiac disease? Before my foray into being diagnosed with celiac disease last year and working in rheumatology I knew precious few people, maybe 1, with celiac disease but many many more with psoriasis and RA. That's because up to 70% of people with celiac disease are undiagnosed.  They are hanging around with a label such as irritable bowel syndrome, lactose intolerance, "colitis," depression, arthritis,  fibromyalgia, etc., when really what they have is undiagnosed celiac disease or non-celiac gluten intolerance.  And it carries what all of the other false diagnoses don't-and increased risk of lymphoma and osteoporosis, anemia and vitamin deficiency, and inflammatory damage to your gut!

My first thought was, wow, there are the same number of people with RA as there are with celiac disease.  And second thought is something like, if our rheumatology practice thrives on patients with RA, doesn't gastroenterology thrive on celiac patients? Based on my experience it does not. My first experience with a gastroenterologist 10 years ago gave me a diagnosis of IBS and sent me on my merry way. My second experience last fall gave me my diagnosis, but no follow up has been recommended.  I was essentially sent back to primary care who, in my case, was really not up to date or educated about celiac disease.

Luckily, I'm also a healthcare provider and a voracious reader. I could spend hours researching online.  I was able to settle into my new gluten free existence without too much fuss especially because I have been tweeking our eating habits for the past two years and going gluten free wasn't quite the hurdle it could have been.  But what about all of the "lay people" who get diagnosed? No one even recommended I see a dietician and the nutritionist I saw was completely unhelpful.  She just wanted me to take a bunch of supplements that conveniently she sells at her store. That didn't settle too well with me.

After months of consideration I've decided that I want to be the help and support for those newly diagnosed or those who think they may need to get diagnosed as well as those who have been doing this for a while and just want some more support working out the kinks.  Yes, I am an Arbonne consultant as well, but I'm not doing this to sell anyone anything other than my knowledge and experience.  I want to be a supporter, encourager and partner in your journey to gluten free-dom.  Need help? Contact me at  Let's see what we can do together for the "health" of it! :)

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