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Vitiligo

Vitiligo, made popular by Michael Jackson, is an autoimmune disease and while doctors have long claimed many of these diseases are life long and can't be cured, we now know that auto-immune diseases and most chronic diseases are in fact the result of triggers to the immune system and ultimately #inflammation. Figure out the trigger or reduce the inflammation and resolution can occur.


Sometimes this means improving nutritional status. Sometimes this is more about environmental toxins, even toxic relationships or stored trauma. Sometimes this is about sluggish detoxification and ultimately a high body burden, which we can work to optimize in functional and integrative medicine. Whatever the cause is though, it indicates the immune system is imbalanced, so ignoring the root cause and treating vitiligo as a cosmetic issue alone is really a disservice to our clients.


Genetics, bacterial overgrowth, food sensitivities, nutritional deficiencies, accumulation of toxins, mental and emotional anxiety have all be proposed causes of vitiligo. Whatever the trigger, the chain of events are set off which results in the immune system attacking the melanin-producing cells known as melanocytes, and this process causes areas of the skin to reduce their pigmentation.



Vitiligo can negatively impact an individual's self-esteem and overall body image. Traditionally ultraviolet light is encouraged, which can be helpful, but not addressing the underlying issue itself unchecked means progression is likely and ultimately, as inflammation continues more and more autoimmune issues will occur. Combining conventional therapies and a holistic approach can help improve health and wellness through the senior years.


Skin starts to shed melanin, the pigment that gives the skin color, when vitiligo is triggered. Melanocytes, the cells that produce the pigment, die prematurely and therefore, no longer protect the skin from damaging ultraviolet rays. This can happen in larger patches all in one area, or small specks of discoloration throughout the body. Early graying of hair and discoloration of the mucus membranes are also indicators of vitiligo.


While there is no specific known cause, and like most autoimmune diseases, it is probably a combination of triggers, there is a genetic component to vitiligo. Recent studies have identified a gene specific to utilization of glutathione, which is the mother of all antioxidants or the super-charged-vitamin C. This one we can't really supplement orally though, so one has to either get this from an intravenous infusion or supplementing N-acetyl cysteine (NAC) can help the body create its own #glutathione. We can offer glutathione to our clients if desired. This takes only about 15 minutes.


Functional Medicine Can Slow Down the Autoimmune Process


In some clients, simply addressing the inflammation or identifying the trigger will recover the pigment in the skin. I've seen this happen actually in fairly large areas. In others, functional medicine approaches will help prevent advancing pigmentation loss. Traditional therapies can be used to stimulate the skin to produce pigment. When we normalize an overactive immune system and there is no more progression, this can resolve and many times remain that way, although future illness or falling back into previous habits that welcomed inflammation can cause vitiligo to present yet again.


Detoxification and methylation is an important part of the functional medicine evaluation, which has had some correlation with vitiligo as well. Research in Italy identified three genetic variations that appeared in higher incidence with individuals diagnosed with vitiligo. In my own practice, I find my clients with vitiligo also report great sensitivity to chemicals, which tells me they likely have some level of detoxification congestion. If you're familiar with these issues, I bet you can already guess the variants identified in this study... you guess it, MTHFR, MTRR, and CBS.


So, MTHFR 677 homozygous states were found at a statistically higher rate in individuals with vitiligo combined with CBS 278TT and MTHRR 66GG. The CBS enzyme (cystathionine-beta-synthase) along with the MTRR enzyme (methionine-synthase-reductase) are part of the methylation cycle and its corresponding transsulfuration pathway. This has a fairly broad impact, so if you're familiar, it extends beyond just avoiding folic acid and supplementing methylated B vitamins. Addressing this though, and optimizing that Kreb cycle, the methylation pathways that help your body detoxify could really make a difference in disease development.


Approaches to Treatment


Conventional medicine approaches vitiligo treatment similar to many autoimmune diseases, with steroids. Antioxidants, tacrolimus and pimecrolimus, prostaglandin E, and vitamin D can be helpful as well. Most commonly light therapy is utilized, with a NB-UVB excimer laser, narrow-band ultraviolet B (NB-UVB) micro-phototherapy, and monochromatic excimer light. However, if we rethink our approach towards addressing the underlying cause, we can expand our options a bit.


If we think systems medicine, as functional medicine is well known, than we can address all the suspected triggers: genetics, hormone imbalances, exposure to chemicals, oxidative stress, viral causes, and anxiety. We want to manage oxidative stress, inflammation, our toxic burden, and support our immune system and balance our hormones.


Inflammation begins in the gut, so adhering to a diet that reduces inflammation is essential in the management of any autoimmune disease, including vitiligo. We do this more often through testing your triggering foods, chemicals and dyes. We would work to increase healthy fats, aiming for an HDL into the 60-70s, by adding omega-3 and omega-9 fats into your diet. Sometimes too this is about utilizing your oils properly, and not cooking with oils that have a lower heat index which would create oxidative stress in your cells. Identifying if you have a gluten sensitivity is important, as more often clinicians work to only diagnose Celiac disease but why only acknowledge those with profound sensitivity and not those who maybe have less significant reaction, but inflammation just the same. Sugar can be an issue as well, which often circles with higher cortisol and belly fat.


Oxidative stress can result from environmental fats, natural wear, or anxiety and stored trauma. It's where the body starts to produce free radicals, damaging and altering our DNA. A diet high in antioxidants can clean this up. Think super colorful foods, like eggplant or blueberries. Incidently, pears and blueberries have hydroquinones which have shown to have depigmentation properties. Oxidative stress and melanocyte survival might be affected by glutathione, an antioxidant released when greens are mixed or juiced.


Stress is no joke. We never give it the respect it deserves. My bestie had a heart attack just a month ago. Her heart was barely functioning in spite of no blockage. She's had significant trauma and her heart attack happened in therapy. She's 49 years old. Stress does kill. Go to talk therapy even if you don't think you have a reason. Think of this like visiting the dentist. Go for a check-up. Make time for processing your emotions, for checking into your mental health, for nurturing your inner child, for attaining greater skills for communication and empathy. Not one of us escaped childhood without trauma, or our twenties, or even our thirties.


If you know me at all, you know I am a fan of yoga and guess what, here's why - a 2015 study found that combined with Ayurvedic medicine, yoga demonstrated improvement in vitiligo. Although I can't say this is an evidence-based statement, it is no wonder because yoga is excellent at causing you to self-evaluate. While on the mat you take time to think about your entire body, what you're doing to help it and maybe what you're doing to work against its efforts to heal. You move lymph and you get yourself into a state of peace, in the parasympathetic nervous system, a state of healing. It's phenomenal and it really kind of bums me out that more of my clients don't take advantage. I do think yoga is transformational.


Okay, so the thyroid is maybe one of the worst managed aspects of our health when in the hands of conventional medicine. Think of this one as the canary in the coal mine, or maybe like your smoke alarm. Don't just pull the batteries out of that siren, figure out why it is alarming! Optimize your hormones but investigate why the thyroid is irritable and inflamed. It's a great barometer for overall body burden.


Botanical Medicine for Vitiligo


While I love me some plant medicine, Chinese medicine is a bit less familiar to me, but Psoralea corylifolia is utilized for vitiligo as it has a pure form of psoralens. Ayurvedic medicine is taking up more and more space in my heart more recently, although again, not quite my niche. I have read though that in #Ayurvedic Medicine healers will utilize the herbs, kutuki and bakuchi, are helpful for vitiligo. These contain psoralen and offer and antioxidant effect which again, can help re-pigment the skin.


Turmeric has been used extensively in traditional Ayurvedic Medicine as well for skin repigmentation. This one is great for inflammation in general. After my last child's birth, super traumatic for me with more than five hours in the operating room, my bestie made me #turmeric soup and stained my KitchenAide mixer. I love this because every time I see it, I am reminded that I am loved.


Ginkgo biloba has also demonstrated anti-inflammatory results, and been useful in treating vitiligo. Replacing methylated B vitamins and silica can be helpful as well. Evaluating homocysteine and cRP, as well as sed rate should be part of the wellness panel.


References

Benincasa, G., Di Spigna, G., Cappelli, C., Di Francia, R., Ottaiano, M., Sansone, M., Iodice, L., De Marinish, E., & Postiglione, L. (2019). High incidence of MTHFR, CBS, and MTRR polymorphisms in vitiligo patients. Eur Rev Med Pharmacol Sci, 23(2), 471-478. doi: 10.26355/eurrev_201901_16858

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