Is this spice good or bad for pigment loss (leukoderma)?
If, like me, you love spicy foods you will be no stranger to #turmeric, the lovely golden spice derived from the root of the curcuma plant and widely used in Indian and Pakistani cuisine.
As well as being a familiar constituent of curry, turmeric also has many medicinal applications. For example, it is used in the treatment of arthritis, headaches, bronchitis, colds, lung infections, fibromyalgia, leprosy, fever, menstrual problems, water retention, intestinal worms, loss of appetite, heartburn (dyspepsia), stomach pain, diarrhoea, intestinal gas, stomach bloating, jaundice and disorders of the liver, kidneys and gallbladder... to name but a few!
Its antioxidant qualities have caused turmeric to be hailed as a superfood and studies have shown its potential for preventing precancerous conditions developing into cancer. It is even believed to be a possible source of future treatments for neurodegenerative conditions like Alzheimer’s because of its apparent ability to break down the amyloid-beta plaques that can build up and block pathways in the brain. Finally, and more mundanely, the anti-inflammatory and antiseptic properties of turmeric have led to its inclusion in countless traditional skin preparations, especially in home remedies for a host of common skin complaints and infections.
One of the skin conditions thought to benefit from this wonder-spice is #vitiligo (loss of skin pigment, or leukoderma). Notwithstanding my love of Indian takeaways, I have never tried turmeric as a vitiligo remedy. But frequent references to it in this context on the internet suggest that there must be something in it, especially in light of the fact that vitiligo is thought to involve an inflammatory process and raised levels of hydrogen peroxide in the skin. It makes sense then that a substance with both #anti-inflammatory and #antioxidant properties would be therapeutic. However, the evidence for this is highly confusing and contradictory.
On the one hand, consumption of turmeric and its topical application (when combined with mustard oil… and maybe this is the key factor in its apparent efficacy) is claimed to stimulate repigmentation in vitiligo lesions. Yet, on the other hand, consumption of turmeric has been cited by the highly respected vitiligo researcher Dr Karin Schallreuter as the most likely reason why many Asian patients whose diets routinely included this ingredient did not respond to #pseudocatalase treatment. Far from raising antioxidant levels in these patients, their consumption of turmeric actually lowered them causing increased oxidative stress. This counterproductive effect of turmeric when taken orally has also been observed when applied topically. Both turmeric and santalol (the main constituent of sandalwood oil) were found to cause further pigment loss when applied to vitiligo patches.
Confused yet? Me too! Of course, there is bound to be a perfectly rational explanation as to how turmeric can be both good and bad for you. Maybe it is just a question of degree. After all, everyone knows that water can be both good and bad: it is a daily essential - in proportion to our physiological needs - to hydrate and detoxify the body, but if you totally immerse yourself in it for more than a few minutes you will drown. So, perhaps it is the frequency and concentration of turmeric in some Asian diets that increases oxidative stress instead of lowering it. Or maybe it is a question of interaction or contraindication. It may be that the combination of turmeric with other dietary ingredients might be the reason for adverse results in vitiligo patients or perhaps the combination of mustard oil with turmeric in the much-praised topical home remedy is the key to its alleged success.
Since I am not a scientist I cannot really do any more than highlight the apparent contradiction of turmeric in relationship to vitiligo, pose these questions and come to my own considered opinion on the subject. The subject is certainly a fascinating one and I will keep my eyes and ears open for more information on it. But, in the meantime, I will still enjoy the occasional curry. However, turmeric will not be part of my nutritional regime and I won’t be putting it directly onto my skin either – with or without mustard oil – until I know much more about the likely effects.
If you read last week’s rather lengthy blog post about the link between #vitaminDdeficiency and #vitiligo you will remember that I left you dangling (because there was just too much to say on this subject in one post)! I referred to the fact that people with vitiligo, #psoriasis and #autoimmune diseases in general are known to be deficient in vitamin D and that at least one clinical study achieved good therapeutic results from giving subjects very high doses of vitamin D3. However, I did stress that rushing out to buy potent vitamin D supplements was not necessarily the best thing to do. So, this week I will explain my reasons for saying this.
My first reason is because vitamin D, of all the vitamins it seems to me, is very complex in the way that it works, so it would be risky to take the simplistic approach that more is necessarily better. As I mentioned last time, it plays a much more complicated and far-reaching nutritional role than was understood until relatively recently and medical science is still uncovering its secrets today. Not only does it act as a vitamin but it also performs hormone-like functions within the body. In addition, the way that it interacts with other nutrients means that finding and maintaining a healthy level of vitamin D is a rather tricky balancing act. Because of this, it is important to understand more about these interactions before going mad with the vitamin D pills. (And, ultimately, your healthcare provider is the person who will be best qualified to advise you on whether or not you should be taking extra vitamin D).
The Vitamin D Council website explains it this way:
The way that vitamins and minerals work in your body is interconnected. How well vitamin D works depends on the amount of other vitamins and minerals that are present in your body. The other vitamins and minerals needed to help vitamin D work well are called cofactors.
To get the most benefit from vitamin D, you must have other cofactors in your body. Vitamin D has a number of cofactors; the ones listed below are the most important.
I fell foul of this delicate balancing act myself when I tried a course of vitamin D tablets and found they made me horribly constipated! At the time I didn’t know that this can be a sign that you are deficient in magnesium (one of the cofactors of vitamin D) but now this piece of information makes sense and when I decided recently to take calcium and vitamin D tablets to help prevent osteoporosis I made sure they also contained magnesium.
Vitamin D promotes the absorption of calcium (which is why, along with its cofactors, it is often found in supplements for bone health). But it is possible to overdose and taking excessive amounts of vitamin D supplements can raise blood levels of calcium to levels which can lead to hardening of the arteries and kidney stones. This risk is presumably the reason why the researchers who carried out the high dosage vitamin D trials I referred to above with vitiligo and psoriasis patients insisted that they cut out calcium-rich foods.
My second reason for not recommending vitamin D as your main vitiligo treatment is because oral supplementation is only as effective as the digestive system. In other words, if your ability to absorb nutrients is compromised – which appears to be the case for many of us vitiligo sufferers - it is hard to know how much benefit you will get from a particular supplement and deciding on the appropriate dosage to compensate for this becomes a matter of guesswork. So, my instinct is that the safest way to avoid upsetting the balance of vitamin D and its cofactors is to “hedge your bets” by making sure your diet includes all of the cofactors as well as bypassing your digestive system by getting vitamin D naturally from regular, moderate sun exposure. If, in addition to this, you decide to add a vitamin D supplement to the equation it makes sense to stay within safe recommended limits.
My final and (for me, at least) most compelling reason is based on personal experience. In spite of my confirmed low levels of vitamin D, I achieved a dramatic and permanent recovery from my vitiligo without taking any potent D supplements. The Boost capsules I took for the duration of my repigmentation contained, per day, 100% of the European recommended daily intake of vitamin D (as well as 20% of its cofactor zinc) but that is not a particularly high dose so I am guessing that it is not the main reason this supplement helped my vitiligo. The The Five a Day+ green food formulation, which I continue to take each day probably doesn’t contain much, if any, vitamin D because it is made from green plant sources. However, it certainly contains plenty of the cofactors magnesium, vitamins K and A and zinc because these nutrients are all plentiful in green, leafy vegetables.
What I am saying is that I was able to recover from vitiligo without addressing my vitamin D deficiency directly through supplementation. On the other hand, supplementing the cofactors of vitamin D – as part of a whole green food containing many other vitamins, minerals and phytonutrients too – definitely was a factor in my repigmentation, as was vitamin D-producing sun exposure.
My conclusion then is that it was the other nutrients in Boost, rather than just the modest vitamin D content, that were mainly effective in stimulating new skin pigment. My moderate UV exposure was probably just enough to avoid being seriously deficient in vitamin D and I was able to get plenty of the cofactors of vitamin D from my green supplementation. What I don't know, of course, is whether taking higher doses of D3 might have produced even faster results but my concern about doing this would be that it might throw the delicate balance of nutrients in my system out of kilter, so I would not, personally, consider taking D supplements in doses any higher than generally recommended.
Sun exposure and supplementation as part of a wider nutritional programme is my advice
What you need to know
As I write this week’s post I am sitting in my garden enjoying some unusually warm UK Spring sunshine and feeling very grateful on two counts: 1. the unseasonably good weather and 2. the fact that I am able to enjoy it without worrying about my #vitiligo. And as I soak up the rays it strikes me that a sunny garden is the perfect setting for this blog topic for reasons that will become obvious as you (hopefully) read on…
I recently visited my doctor on a general health matter which required various blood tests. The consultation had come to a close and I was just about to leave when she happened to mention, as an afterthought, that my levels of #vitaminD were borderline deficient and suggested I sit out in the sunshine for 20 minutes every day - in the middle of the day - to try to increase them. (If you aren’t sure what the connection is betweensun exposure and vitamin D I will explain in a moment.)
Of course this is the sort of medical advice most people would welcome as a great excuse for lounging about in a deckchair (and, since finding a vitiligo treatment that involves a certain amount of exactly that, I’m no exception!) But, the fact is that I have been taking a daily dose of vitamin D in my supplements equivalent to at least three times the recommended daily dose for years and I do already take every possible opportunity for sun exposure. So, when I told my doctor this, she concluded that, without the supplements and sunshine, I would most certainly be deficient. Of course, my medical records show that I had a long history of vitiligo. But, if my doctor was aware of any link between vitiligo and vitamin D deficiency she didn’t let on. So I decided that, once again, it was time for some more research into the subject.
Over the past few years I have come across plenty of vitiligo literature linking vitiligo to vitamin D deficiency but I was not clear as to which condition causes which (“chicken and egg” again). As it turns out, it appears to be a bit of one and a lot of the other! On one side of the coin, having vitiligo usually causes sufferers to stay out of the sun for fear of burning or drawing attention to their white patches by tanning the rest of their skin and this naturally results in reduced levels of vitamin D. But more interestingly, on the other side of the coin, research shows that individuals who have vitiligo, psoriasis and various autoimmune conditions have subnormal levels of vitamin D to start with. So, it seems that having vitiligo almost certainly means you are low in vitamin D in the first place and if you then also avoid sun exposure, as most vitiligo sufferers do, you are making a bad situation worse.
Before you get too depressed, I have come to realise that with every bit of bad vitiligo news there is some good news too because every problem flags up a potential solution. In this case, once you are aware that vitamin D deficiency is linked to vitiligo, an obvious solution is to take vitamin D supplements and also get more sun exposure. But do read on before dashing off to the nearest healthfood store, because it is not quite as straightforward as that. There is some homework to do first on the subject of this tricky vitamin!
Historically, the role of vitamin D has not been well understood but over the past several years it has become a hot topic, with new research papers appearing on a very regular basis leading to a much greater awareness in medical circles, and in the media, of its importance .
Believe it or not, scientists don’t always agree as to whether vitamin D is a vitamin at all or rather a hormone. The scientific arguments can seem baffling unless you are well versed in science – which I’m not. So, before going any further, here is an idiot’s guide to vitamin D (designed, by me, for people like me!).
It seems that vitamin D is undeniably a vitamin, i.e. an organic substance present in natural foods that is essential to normal metabolism and, if depleted, may cause deficiency diseases. But it also acts like a hormone, i.e. “a substance formed in one organ but transported in the blood to another organ and capable of altering the functional activity of that target organ.”
There are two types of vitamin D: D2, which is what doctors used to prescribe for children with Rickets, and D3 (or “cholecalciferol”), which is what you find in most over-the-counter supplements. Of the two, vitamin D3 is now the vitamin D of choice for supplementation because of its superior therapeutic value. It is also the same type of vitamin D that your body produces in your skin and which is responsible for the pigmentation process after exposure to the UVB light present in sunshine (and, of course, in UVB phototherapy). This is why my doctor prescribed sun exposure when she realised my vitamin D levels were low.
The reason we are so reliant on sunshine for the production of this vitamin is that only small amounts of it are available in the diet. It is worth knowing that D3 (the more therapeutic type) is only found in animal-based foods (especially oily fish, egg yolks and raw milk) so if you follow a vegetarian or vegan diet in your quest for better health and better skin you may be even more prone to D deficiency than those of us who do include these foods in our diet.
To return to the subject of my doctor’s advice, it has been my experience that mainstream medical doctors hardly ever mention the word “vitamin” (and rarely talk about nutritional supplementation) so the fact that vitamin D has made its way into the vocabulary of routine western medicine just goes to highlight the superstar status this vitamin has attained. (In fact, vitamin D even has its own “fan club”: the Vitamin D Council, a California-based non-profit organisation set up to educate people on the importance of sun exposure and vitamin D and their blog is well worth following.)
It seems to me there is still a real lack of joined-up thinking among GPs. The impression I get is that they are generally aware of the health risks of not having enough vitamin D (hence, my doctor mentioned it in general and as an afterthought) but they are not good at identifying deficiency as a potential cause of apparently unrelated illnesses (hence my doctor didn’t make the connection between my long history of vitiligo, CFS and fibromyalgia and my recent borderline-cancerous ovarian cyst – all proven indicators of vitamin D deficiency). I am not blaming my GP for not having the time or the resources to play the diagnostic detective but it does serve as a reminder that our western health system has its blind spots and that some intelligent, in-depth googling in the right places can be a sensible thing to do if you are determined to take responsibility for your own good health.
Having said all of that, vitamin D supplementation is definitely not without its pitfalls. For example, every time I have added separate D supplements to my nutritional regime in the past I have immediately suffered some very unpleasant side effects and, not surprisingly, given up on them again. So, as this is a whole subject in itself, I will leave you with that cliff-hanger and continue with that topic next time :)
Or is it the other way round?
The subject of my previous post was the theory that a possible cause of vitiligo is something called mitochondrial failure and I will be returning to this subject later in this post.
But first, since this is Easter weekend, it seems appropriate to point out that, when it comes to identifying the cause of your vitiligo, it can be a bit like the proverbial Chicken and Egg. If you are one of the many #vitiligo sufferers that also have other health issues, you may have wondered if those other conditions caused your skin to lose pigment or whether the vitiligo caused your other illnesses.
My own medical history and subsequent recovery from vitiligo has led me, very clearly, to my own conclusions as to the cause of my white patches. Logic told me that my vitiligo must be the result of a malfunctioning digestive system. My reasoning for this was that I had suffered all my life with #IBS (Irritable Bowel) symptoms and vitiligo, both of which had only ever become worse over time, yet both of which improved dramatically and unexpectedly when I put myself on a specific nutritional programme. It seems self-evident that poor digestion was robbing me of nutrients that were essential to the normal pigmentation process.
But, as I said in my previous post, trying to be certain of the actual roots of a condition like vitiligo is like peeling the layers of an onion away to reveal yet more layers beneath. And, if - like me - you do suffer from several different symptoms at once it can feel as if you are having to peel the layers off a whole string of onions!
My other “onions” are not diseases, as such, but syndromes: clusters of symptoms that so commonly occur together that they are given a name, in this case, Chronic Fatigue Syndrome (#CFS or ME, as it is sometimes known) and #fibromyalgia. I have lived with both these syndromes all my adult life and for decades I never made a connection between my constant exhaustion and sore joints and muscles and my loss of skin pigment. But it now seems obvious to me that all these symptoms were the result of nutritional deficiencies caused by a malfunctioning digestive system.
But what caused the digestive system to malfunction in the first place? Well, I promised to come back to the subject of mitochondria (the tiny energy-producing compartments within the cells of the body). There is certainly scientific evidence that points to the failure of these mitochondria as a possible root cause of vitiligo. But, what is also intriguing, to me anyway, is that they are also thought by some to be the root cause of CFS and fibromyalgia too. What’s more, mitochondrial dysfunction appears to link all of the above with IBS.
Obviously, I am approaching a very complex subject here from the point of view of someone with no scientific background whatsoever. The whole area of #mitochondrial research is, clearly, much more complicated than I am making it sound. But, as far as I'm concerned, the fact that vitiligo, IBS, CFS and fibromyalgia appear to share some sort of common ground is fascinating in itself and I imagine will be of interest to those of you who also suffer from two or more of these conditions.
My name is Caroline.