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Dietary Approaches, Immunosuppressants, and his Feet
from Mike B.

Hi Ed and all,

Thanks, Ed, for your fairly extensive reply  to my last email in the May-June update .

It sounds like your "third leg" thinking is along the lines of Pagano's work, and while I've been (and remain) skeptical about that aspect of psoriasis, I certainly have to concede that empirically, dietary changes have worked for quite a few people so it's quite likely that the intestinal system is a significant factor in at least many cases. Given that P. is so individualized in its nature, I'd still question whether the intestinal thing is a factor (or at least a major one) in ALL cases. But of course if treatment along that line works for you (or for whoever), by all means go for it.

I have to agree that probably the biggest problem in treating P. is that we're still working on a symptomatic level rather than trying to get at the root cause, whatever that is. I suspect that's why the most effective treatments are those which, one way or another, work as immunosuppressants despite the obvious corresponding risks involved.

To update my own case, I don't see my derm again till the beginning of September. Methotrexate by itself is not doing much good, and scaling is definitely returning slowly but surely, although so far (knock wood) there's still little or no itching. My last blood work was early May, and apparently it came back good enough that not only has he renewed my prescription but he's also decided there's no need for further blood monitoring till he sees me this fall. I suspect at that point he'll decide to report that the MTX isn't working for me either, so I can get drug-coverage approval to get started on Humira. From reading around, it sounds like Humira is one of the least problematic of the current crop of biologics in terms of side- and after-effects (other than its immunosuppressive properties, of course), so probably the least risk even if it turns out not to do much good.

Biggest problem is my feet those sores are quite painful, and my family and friends agree I'd better push the derm for a firm diagnosis and appropriate treatment when I see him. My family doc did send me for glucose testing about three weeks ago, and with lab work he takes an "unless you hear back from me ..." approach, so I think we can still safely rule out diabetes. His usual reaction is to ignore anything in the normal range, though I'd certainly be curious to learn where in that range it currently is since it was quite low-normal most of my life ... while I'm obviously no professional, I'd personally be inclined to think a swing from low-normal to high-normal would itself be significant enough to take a closer look at.

Best always, -Mike B.


Ed’s Response: With regard to dietary approaches to treating P, I hope you read both my interview with Keith White and my review of his book, Healing Psoriasis Naturally, Pulling It All Together in this update. I, like you, have had difficulties unifying the dietary approach with the immune-system-dysfunction approach ever since I interviewed Dr. Pagano in 2005. But every time I nibble at the periphery of the dietary approaches (pun intended) I learn something new and, with this update’s experience, I think some unification of the two approaches is on the horizon (at least, on MY horizon). When I asked Pagano about the immunosuppressive therapies for P, he said the approach didn’t “go back far enough.” I now understand what that implied. Pagano was agreeing that the formation of psoriasis lesions on the skin was the result of an immune system response, but simply muting the response doesn’t solve any problems other than the presence of the lesions. He is suggesting that the immune response isn’t a “dysfunction,” it is an understandable function of the body’s inability to get rid of toxins – toxins we largely get from diet exacerbated by lifestyle. Furthermore, simply blocking the immune system’s response is likely to force the body into other “immune responses” that have their own, probably undesirable, consequences. The science of immunology isn’t, yet, very available to laypeople. And I don’t know how well the plain English descriptions of alternative therapies in the naturopathic literature read true. Until we can understand the immune system a little better, we’re not going to be able to make confident decisions about how we treat our psoriasis. A lot of us – me included – would love to see the immune side fully explained and treatments to suppress it completely successful. I want to be lesion free for life without losing the foods I love and the lifestyle I enjoy. The naturopaths wish us well but feel sorry for us. In their eyes, we are doomed.

How come, we might ask, only a small percentage of those subsisting on meat-heavy and fast food diets get psoriasis? This is a common question raised by psoriatics like me who are resisting the naturopathic therapies. The answer is one of those places where both the immunologists and the naturopaths find neutral ground: genetics. Heredity. A few weeks ago, on PsorChat, an observation was made and then confirmed several times over, that these individuals (psoriatics all) either “didn’t perspire” before they got psoriasis or perspired very little. Well, perspiring is one of the ways we detoxify. The author of the pH Miracle calls the skin our “third kidney.” My eyes widened over this discussion because I, too, perspired very little (until AFTER my quad-bypass and valve replacement surgery in 2007). Is reduced or non-existent perspiring a genetic factor that contributes to skin psoriasis? We need to find out.

Re: Your feet. Given your long history with “sock-like lesions” on your feet, I’m not surprised by anything, but sorry this round of feet lesions (if that’s what they are) is hurting. I’ve been there, too, Mike. I can’t recall off hand: Did you say you’ve already consulted a podiatrist?  Given your blood work (normal glucose range) and the pain, if I were you I’d go to a podiatrist. Feet are weird. My dermatologist didn’t want to deal with mine in the mid-1990s. He took one brief look and sent me straight-away to a pod-doc.

I’ve been told that foot problems resulting indirectly from diabetes are caused by poor circulation, which diabetes exacerbates when glucose-engorged blood cells clog (or slow passage through) the capillaries, hence causing serviced cells to starve. What starts out looking like bruises (light to dark blue) but then becomes black (necrotic) is an indication. Your docs should be able to explain this to you in depth.

At one point, when I thought I was developing some circulation problems in my feet, my doc prescribed “socks for diabetics” and I purchased a pair (way overpriced, in my estimation). I know now how they work. If you don’t routinely inspect your feet, and if you are experiencing any kind of neuropathy down there, you may not notice pain or discomfort associated with necrotic tissue or slight wounds that get infected. Most of us don’t fall into the habit of thoroughly inspecting our feet. That’s where the socks come in. They won’t “stay up.” They fall down around the ankles all the time, and because they are made out of mink fur (or something just as expensive), they feel weird all bunched together between the top of your shoe and the ball bone in your ankle. Therefore, you are bending over your lap hundreds of times per day to pull up your socks. Every now and then you’re inclined to inspect your feet just so you don’t have to sit up again right away.  -Ed

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