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Hives and other chronic and itchy skin rashes can be one of the reactions that you may manifests as a result of a gluten allergy. Since you can’t be allergic to your own skin, the allergy or intolerance must actually lie with the gluten you consume.

People with gluten allergies may suffer from any number of unpleasant symptoms, triggered by their bodies’ inability to properly digest gluten. The symptoms can range in frequency and severity and may include migraines and lethargy, to gastrointestinal problems such as diarrhea or constipation, to skin problems. Going on a life-long gluten-free diet is the only method of managing this condition.

People with gluten allergies produce extraneous amounts of the IgA antibodies as a reaction to gluten in their systems. This reaction is considered an autoimmune response to what the body perceives to be an “invasion” by a foreign and unrecognisable substance. The body creates special antibodies to attack the gluten proteins; however, in the process it also begins to attack its own protein tissues. In some people the body deposits the antibodies into the skin. These antibodies are triggered when the gluten, which is absorbed into the bloodstream, is circulated around the body and deposited in the dermis (skin). This interaction results in eruptions on the skin that manifest as a blistering, burning and itchy rash known as Dermatitis Herpetiformis.

While Dermatitis Herpetiformis can affect any area of the body, it is mainly located on the scalp, elbows, buttocks, knees, legs and back. Research shows that Dermatitis Herpetiformis is not a common reaction to gluten, and it affects more men than women. People with Dermatitis Herpetiformis should get tested for gluten enteropathy, the most common form of celiac disease.

An elimination diet is the only way to control Dermatitis Herpetiformis. Even then, once you have gone gluten-free it may still take months, or even years, until the Dermatitis Herpetiformis completely resolves.

Can a gluten-free diet help your psoriasis?

With gluten-free diets getting more and more attention these days, you may wonder if going gluten-free would help reduce your psoriasis symptoms.

The jury is still out on this topic, but, in some cases, eliminating gluten—a complex protein found in wheat, barley and rye—does seem to help reduce psoriasis. In a smaller number of cases, eliminating gluten can lead to dramatic improvements. However, following a gluten-free diet, which is very restrictive, is a major commitment. It’s not a step you should take unnecessarily.
Is gluten-free right for you?

To understand why—and if—eliminating gluten might be right for you, it’s important to understand why and how gluten can cause problems for some people.

Gluten allergy: Experts estimate that up to 2 million people in the U.S. may suffer from an allergy to gluten, which is found in bread, pasta, crackers and other baked goods made from wheat, barley, or rye. Less obvious are processed foods, from lunch meats to salad dressings, that can also contain this potentially problematic protein.

A gluten allergy means that the body forms antigens in response to the protein, activating an immune system response and possibly also spurring on any autoimmune disorder, such as psoriasis, in the process.

Common symptoms of a gluten allergy include diarrhea, bloating, headaches, canker sores, fatigue, irregular menstrual cycles in women, joint pain and sleep problems.
Celiac disease: A gluten-free diet is the only known treatment for this autoimmune disease, a digestive disorder that can damage the small intestine. It is diagnosed through a simple blood test.

Some experts suspect that psoriasis, also an autoimmune disorder, may share a connection to celiac disease. Other experts believe that the two conditions are not necessarily directly connected, but rather that a subset of people with psoriasis also happen to have celiac disease or gluten intolerance as well.

In either case, for these people, eliminating gluten from their diet would be recommended and could help reduce symptoms of both conditions.
When gluten-free isn’t a good idea

For someone with psoriasis who does not also have celiac disease or who is not allergic to gluten, it is not advised to follow a gluten-free diet. If gluten isn’t the culprit, there is no need to give it up. It can be difficult to maintain a balanced diet when eliminating the many foods that contain gluten.

If you suspect you may have celiac disease or cannot tolerate gluten, you may be tempted to eliminate gluten from your diet on your own. But experts advise that you first call your doctor and schedule a blood test to check for the allergy. Talk to your doctor and/or seek advice from a registered dietitian on how to start a gluten-free regimen in a systematic way. If you eliminate more than one food at a time, for example, it can be hard to know which food or foods were actually the problem. It could take up to 90 days to see a true result. A dietitian can help you make a list of gluten-free foods to make sure you get the nutrients your body needs.

It is also possible that gluten isn’t contributing to your symptoms, but that another food such as dairy, sugar, corn or soy might be.

Bottom line: Eliminating gluten from your diet may help reduce your psoriasis symptoms as well as eliminate digestive woes, but it’s only likely to help if gluten is a problem food for you in the first place.

Basics of Sleep Apnea and Ischemic Stroke
Recent study in Germany discovers connection between untreated sleep apnea and several other medical problems.
Jessica Kepplinger, MD (Disclosure)
Kristian Barlinn, MD (Disclosure)
Andrei Alexandrov, M.D. (Disclosure)

March 26, 2013

Sleep apnea is frequent in patients with acute ischemic stroke
Although many early epidemiological studies found an association between sleep apnea and cardiovascular diseases, it took a long time until stroke clinicians and scientists adopted the notion that sleep apnea has potential deleterious effects on the cerebral vasculature as well. While in the general population approximately one in ten adults suffer sleep apnea of various subtypes and degrees, its frequency in acute stroke patients appears much higher, reaching almost 70%.1-3

Sleep apnea is a risk factor for acute ischemic stroke
Two prospective cohort studies revealed a 2- to 4.5- fold independent risk for a first-ever ischemic stroke in patients with sleep apnea compared to those without,4-5 suggesting that sleep apnea constitutes a pre-existing condition rather than a consequence of acute ischemic brain damage. Moreover, the cumulative risk of suffering a recurrent ischemic stroke may grow notably in stroke victims who have co-existing sleep apnea.6,7 Yet it still remains a matter of debate whether the deleterious effects of sleep apnea are independent of other comorbidities often existing in those who have suffered a stroke, such as hypertension, atherosclerotic disease or atrial fibrillation.

The pathophysiologic mechanism by which sleep apnea contributes to cerebrovascular complications is not fully understood
A variety of mechanisms such as inflammatory processes, endothelial malfunction, enhanced activity of thrombocytes and coagulation factors leading to hypercoagulable state, and progression of atherosclerosis may trigger atherothrombotic and embolic strokes.2,8 The latter mechanism is supported by a recent observation that the intima media thickness in the carotid arteries, a marker for general atherosclerotic burden, seems much more accentuated in patients with sleep apnea than in those without.9 Cardiac arrhythmias may be of particular interest, as approximately 50% of patients with atrial fibrillation presenting for cardioversion have obstructive sleep apnea as compared with 30% in the general cardiology population.8 Also, intrathoracic pressure changes in patients with obstructive sleep apnea may boost the risk for paradoxical embolism in those who have a co-existing patent foramen ovale, justifying further diagnostic evaluation for sleep apnea. In addition, a wide spectrum of further cardiovascular abnormalities affecting systemic hemodynamics (i.e., increased sympathetic activity, disturbed heart rate variability) has been reported in patients with sleep apnea.8 However, the variety of proposed underlying mechanisms might explain why no particular stroke etiology (e.g., large artery atherosclerosis, small vessel occlusion, cardioembolism, other cause, undetermined cause) has been linked to sleep apnea so far.1,2 Of note, the assumption that abnormal cardiovascular responses to nocturnal apnea episodes contribute to sleep-related ischemic strokes has not been fully supported by various studies with divergent results.(10)

Sleep apnea may alter cerebral hemodynamics
Sleep apnea may negatively influence the clinical course in the acute phase of ischemic stroke. More specifically, up to an 8-fold increased risk for early worsening of neurological symptoms within 72 hours from stroke onset has been described.11 In patients with sleep apnea, cerebral autoregulation is impaired as demonstrated by transcranial Doppler studies,12 putting further brain tissues at risk of ischemic injury. In the most severe case, this may lead to depletion of the collateral blood flow when vessels in the non-ischemic area dilate more, leading to blood flow diversion from the ischemic area to the non-ischemic areas. This process is mediated by vasomotor reactivity in response to simple stimuli, such as arterial carbon dioxide increase with hypoventilation. Apnea may further worsen hypoperfusion in the ischemic brain area. This “cerebral blood flow steal – phenomenon” was demonstrated by transcranial Doppler in real time. When it lead to early neurological worsening it was termed the reversed Robin Hood syndrome as it serves “to rob the poor to feed the rich.”13 When found during the initial hospitalization for an ischemic stroke, this syndrome leads to a 4-fold increase in stroke recurrence within the same arterial territory.14

Sleep apnea needs to be considered when it comes to secondary stroke prevention
As with other vascular diseases, secondary prevention is crucial for short- and long-term outcome as well as recurrence risk in patients with acute ischemic stroke. Organized stroke unit care enables optimized acute stroke management, early detection of the underlying stroke etiology and corresponding vascular risk factors. Improved outcomes and reduced recurrent stroke risk for patients admitted to a stroke unit have been shown as opposed to patients who are admitted to a general neurological ward. However, acute management and routine screening for sleep apnea in acute ischemic stroke patients has not yet been implemented in stroke guidelines. As recently shown, the early utilization of cardiorespiratory polygraphy, an easy-to-handle unattended screening device, allows proper identification of stroke patients with sleep apnea and its routine implementation on a stroke unit could facilitate appropriate post-stroke sleep apnea management.(10) Moreover, sleep apnea and intracranial blood flow steal represent novel and linked therapeutic targets for both early correction of brain hypoperfusion and secondary stroke prevention.15

Non-invasive ventilatory correction for acute ischemic stroke patients
Some, though not all studies have shown the safety and beneficial effects of non-invasive ventilation on improved quality of life and reduced cardio- and cerebrovascular morbidity and mortality in the general sleep apnea population. However, only a few studies investigated the use of non-invasive ventilation in stroke patients and the definite benefit for a better clinical outcome. For example, continuous positive airway pressure (CPAP) started within two months from acute stroke onset lead to a reduced 5-year-mortality and a reduced 7-year- stroke recurrence rate.16,17

In the acute phase of ischemic stroke, an ischemic tissue-at-risk (i.e., penumbra) may be present for many hours and amenable to reperfusion. Consequently, any treatment that potentially augments cerebral perfusion may be justified. Administration of oxygen via nasal cannula, as is commonly performed in many stroke units, may not be sufficient to reverse cerebral hemodynamic disturbances that may occur during apnea episodes and may result in acute deterioration in stroke patients with sleep apnea. In fact, hypoxemia and hypercapnia may affect cerebral blood flow by inducing vasodilation, and diversion of blood flow during hypoventilation or apneic episodes was established.13-15 To counteract potentially harmful effects of sleep apnea, recent approaches focus on the prompt initiation of CPAP or bilevel positive airway pressure (BPAP) in the hyper-acute phase of stroke, when hemodynamically compromised tissue can potentially be salvaged. However, only a few smaller investigations aimed at tolerability and safety showed promising results.18-20 However, most of these studies had to deal with low recruitment rates and poor patients adherence to treatment, a well-known issue that may be even more pronounced in stroke patients due to post stroke-related neurological impairments. Auto-titrating non-invasive ventilation devices seem to be worth further investigation as tolerability exceeds common devices.21 Currently, a multicenter randomized trial utilizing auto-BPAP in acute ischemic stroke patients within 48 hours from symptom-onset is underway and will contribute to a better understanding of how early treatment with non-invasive ventilation helps to counterbalance, or possibly reverse, the deleterious effects of sleep apnea in acute ischemic stroke patients.
Key Learning Points

Sleep apnea is very frequent among ischemic stroke patients and contributes to an increased risk for both first-ever and recurrent ischemic stroke. Also, it may affect the clinical course and short- and long-term outcome in acute ischemic stroke patients negatively.
As part of secondary stroke prevention, screening for sleep apnea should be considered in organized stroke unit care as it is done for other well-known vascular risk factors.
The benefit of non-invasive ventilation in ischemic stroke patients is not completely elucidated. In the acute phase of stroke, further studies are needed to show whether early initiation of non-invasive ventilation has a beneficial effect.

These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the “peer review” process, in which outside experts scrutinize the data prior to publication in a medical journal.

NIH.gov: Effect of dietary protein content on weight gain, energy expenditure, and body composition during overeating: a randomized controlled trial.

Interesting study showing calories are not created equal.
25 volunteers admitted to the metabolic ward and divided into 2 groups. Both groups where overfed by a thousand calories per day, one group was on a low protein diet (5%) other on moderate protein diet (25%).
 At the end of the study low protein group lost 1.5 pounds of muscle and gained 7.5 pounds of fat. Moderate protein group gained 6.3 pounds of muscle mass. Tthey also gained fat but much less than the low protein group.
This clearly shows that not all calories are equal. Some foods especially high in glycemic carbohydrates can trigger an insulin response that promotes fat gain. These foods are also hyper-palatable (ie, very tasty), which can lead to overeating easily.
Carbohydrates raises the blood sugar and lead to hormonal changes (increased insulin) which promotes inflammation, and increased fat accumulation, especially in the waist and thigh area depending on the body type.
Diets higher in protein and fat (healthy fats) are highly satiating, promote metabolically active muscle mass, and can speed up the metabolism.
Bottom line:
  1. Avoid sugar, foods with HFCS, and carbohydrate dense grains.
  2. Eat at least 20-30gm of protein with each meal along with healthy fats.
  3. If weight is a concern, keep the total carbohydrate intake to less than 100gm per day, mainly from safe sources likes roots, tubers, vegetables and low glycemic fruits, like berries.
  4. You can also time the carbohydrate intake within 2 hours after a work out, when the insulin sensitivity is high.
So next time you see a label, and it says “only 100 calories per serving”, don’t fall for it. Make wise choices when it comes nutrition.
Hopefully you can implement these simple tips right away, and have an immense impact on improving your health.
Love to see your comments in the section below!

2013-05-03 10.36.38

Finally online!
I wanted to do this for a long time, at last I found the help to get me set and here we go. This is going to be free format. I will talk about neurology, Gluten free diet, fitness, recovery, sleep, herbal therapies, hormone balance, stress etc.
This may be little slow and bit painful even to start, but I am looking forward to sharing very valuable information to improve your overall health and to maximize your performance.
Wish me luck folks!

Copyright © Wake Neurology 2013

130110142125-largeA new study out January 10 in the journal Science turns two decades of understanding about how brain cells communicate on its head. The study demonstrates that the tripartite synapse — a model long accepted by the scientific community and one in which multiple cells collaborate to move signals in the central nervous system — does not exist in the adult brain.