THE VITILIGO IN ME
My first encounter of feeling “exposed” with vitiligo was towards my final year at university. A significant point in my life in many ways. Like most students, I allowed my appearance influence many choices in life – the food I chose to eat or not eat, what I chose to read, what I felt I should be aspiring to, and also what I should be doing for my prospective career. If you knew my quirky self-back then – you would have thought I got dressed in the dark- wacky colours and bold prints were a way to take myself lightly but in fact, it was a distraction from the skin I was in.
Clearly already conscious of my physical appearance (I was always labelled the big one) and now the idea of having vitiligo left me feeling like I was inadequate. I felt like I would never meet the expectation of what society deemed as perfect. As people, we fear being shamed and I truly believed the patches that were growing across my chest, neck, arms and legs would take over, steal my identity and present me as being ‘imperfect’. My skin was the one thing I felt I couldn’t hide even if I wanted to. It would be the thing I felt the whole world could shame me with. Not true in the slightest but it’s how I felt at that period in my life.
I guess I limited myself to see it as another setback. The wonderful thing of hindsight – you have the ability to reflect and grow. I now recognise I boxed myself into thinking I could only be what society had been conditioned with. Those images splashed across glossy magazine covers alongside the fashion industry glorifying “perfection”, in not only what size and shape should look like, but also what flawless skin, hair and make up should be. These were the aesthetics that suggested would make us happy and confident. In reality – this truly just existed in that picture perfect shot – nothing beyond the shot and certainly not after.
As the years grew on, I developed a cascade of health implications and my vitiligo became part of a list of issues I didn’t quite understand but desperately wanted to gain control off. There was a pivotal turning point in which things gradually shifted and my health concerns turned a corner – not overnight surely but gradually. For me understanding vitiligo, not as an isolated skin disorder but rather understanding its causative, which is looking at it as an autoimmune immune condition, which means it is a response of the immune system from a stimuli, lifted a cloud. Understanding autoimmunity was the key to then try and support my vitiligo. As my depth and breadth of food and lifestyle changed, my state of mind opened up a new view point and I was more self-accepting and trusting of myself including all the characteristics that came with me.
Today, we understand the importance of mental health and it being pinnacle in health and wellbeing. Feeling in control of yourself and managing how you feel is influenced by what we do for ourselves and what we eat and drink. It is a lifestyle movement which is finally taking liberty – self-care will continue to be the heart of my practice which focuses on nutrition.
WHAT IS AUTOIMMUNITY?
There are over 100 autoimmune conditions listed, which is when our immune system mistakes healthy cells as invaders and consequently starts attacking on the body’s own tissues, organs and cells, resulting in a multitude of symptoms which could be the heart, brain, nerves, muscles, skin, eyes, lungs, the digestive tract, and blood vessels. In the instance of vitiligo, the immune system attacks the pigment cells (melanocytes) in the skin. From a nutritional stance, to manage vitiligo – the consensus would be to support autoimmunity as a whole, which in turn can subsequently support vitiligo. Whilst there may not be a “cure’’ for the condition, the appropriate diet and lifestyle for you, may help slow down progression, offer some re-pigmentation for some individuals, and may support the symptoms associated with the condition or accompanying autoimmune conditions. As we understand autoimmunity, we know if there is prominence of one autoimmune condition, we are likely to have another. Whilst this can feel quite overwhelming, there is exciting evidence supporting the relationship of food, diet, environmental and emotional factors all playing a pivotal role in supporting the immune system in autoimmunity. With vitiligo, there is known associations with biochemical and oxidative stress, genetics, neuronal and environmental factors which attribute to the condition.
WHAT CAUSES AUTOIMMUNE DISEASE?
Whilst there are many antecedents, triggers and mediators for autoimmune disease, we understand that our mitochondria is compromised in performance with autoimmunity. Mitochondria is known as the powerhouses of each of our cells. These organelles composing themselves like our digestive system take nutrients, break them down to create energy rich molecules in each of our trillions of cells which make up our body tissue, such as muscle, skin, and bone tissue.
The immune response is a hugely complex system and yet so much is to be discovered but to simply extrapolate in context, it relies on a network T Cells. These T cells are known as Naïve t- cells which communicate with sister T- cells known as effector T cells. These effector cells rely on the signaling from naive T cells for when to attack and fight against any foreign pathogens seen as a threat which includes food, environmental toxins, prolonged stress or trauma, or all of the above. Over time, an over activation of effector T- cells can further damage tissue if in excess, like the straw that breaks the camel’s back – this can potentially activate autoimmunity or acute and chronic inflammation.
FOOD AND AUTOIMMUNITY
Due to the nuances in between each autoimmune condition, there is not a “one size that fits all” approach. For instance, what works for someone with type 1 diabetes may vary for someone suffering with vitiligo. Whilst there has been predisposing genetic risk factors involved in autoimmunity, studies have strongly found the “Western lifestyle” including environmental factors make up a significant part of the initiation and propagation of autoimmune disease.
Growing evidence suggests a typical ‘Western diet’, rich in saturated fat and salt, refined sugar high consumption of poor quality animal protein, especially red meat and dairy, can have a profound impact on both local and systemic immune responses leading to inflammation and chronic disease which is shown to be due to their pro-inflammatory effects. All further influenced by our gut microbiome which is also compromised by the western diet and lifestyle.
What we understand about inflammation is it can be stabilized by Interleukin-23 (IL-23), a protein that regulates our immune system. So when looking at supporting our inflammation, management and removing foods and lifestyle habits which exacerbate symptoms, is a sensible way forward.
With any dietary changes and health modifications it is always advised to speak to a health care provider / Dietician and work alongside a practitioner to receive a tailored approach according to your circumstances and lifestyle, but whilst seeking help there are some simple changes you can employ in the meantime.
WHY GOING GLUTEN-FREE MAY HELP
The human diet has dramatically changed over the last 50 years. For generations, humans ate food shortly after harvesting and when it was in season. Meat was very occasionally consumed and much of it was caught in the wild. We have developed new strains of grains, especially in wheat, rice, soy, and corn. The use of chemicals like pesticides, fungicides, and insecticides for crops such as fruits and vegetables have heavily thrusted modifying our soil state further compromising its mineral composition. Cows are now injected with hormones passing them on into dairy products like cheeses, yogurts. Antibiotics, heavy metals, such as arsenic, and hormones are used in concentrated animal feeding operations, which include cattle, turkey, and chicken. All of which we go on to heavily and consistently consume. E.g. a slice of white toast or cereal in the morning, a sandwich or take away burger for lunch and maybe a microwave meal thickened with wheat amongst high sugar, trans fats and salt content for dinner. Chemical ingredients in our foods such as artificial preservatives, colorings, and flavorings; artificial sweeteners are used abundantly, especially in soft drinks. We consume more than twice the amount of salt that we should, leading to cardiovascular disorders and contributing to immune reactions leading to autoimmune disorders.
In autoimmunity – one of the coinciding symptoms is often digestive problems – bloating, IBS type symptoms, indigestion, stomach acid etc., Gluten is one of the many factors that may contribute to intestinal discomfort and this is associated with many autoimmune diseases. Whilst at present there are many theories for why gluten acerbates autoimmunity – studies have shown in gluten free v placebo participants, when gluten is removed, autoimmune symptoms improved from both a gastrointestinal and systemic perspective too. This could be due to our digestive enzymes no longer having the ability to break down the gluten protein found in grains like wheat and rye due to the change in grain constitution over the years. Or it could be the crops are now grown with fertilisers. Replacing gluten with healthy wholesome sources is important. Simply replacing it with heavily processed high fat, sugar and salt gluten free goods will not only be counterproductive, but can aggravate symptoms further.
Options include, Organic quinoa, buckwheat, brown, red or wild rice, millet, oatmeal.
REMOVING OR LIMITING LECTINS
Lectins are a type of carbohydrate binding protein which adheres to cell membranes in the digestive tract – hence making them harder to digest especially for those with food sensitivities. Lectins are found in grains (especially wheat), dairy, legumes and nightshade vegetables (white potatoes, tomatoes, aubergine, bell peppers, cayenne pepper, paprika). These can all be nutritiously dense so having these sporadically by soaking, fermenting, cooking or high-pressure cooking will decrease the lectin content.
EATING A RAINBOW
Oxidative stress is a primary mechanism of inflammation and continues to be extensively studied for its pathogenesis in autoimmunity, inflammation and tissue damage including in vitiligo. Eating a rainbow of fruit and vegetables provides a range of antioxidants and polyphenols to help combat oxidative damage and reactive oxygen species (ROS) (also known as free radicle damage). These are substances produced from fried foods, alcohol, smoking, pesticides, air pollutants – just some of the toxins which cause damage to our cell and cellular function. Consuming a range of fruits and vegetables offer anti-oxidant support which inhibits these oxidative reactions. Fruits and vegetables are also rich in fibre which are vital for gut health and the microbes which aid digestion and lower inflammation in our body.
Cruciferous vegetables like Kale, Cauliflower, Broccoli, Brussels sprouts, contain phytochemicals to protect us from inflammatory autoimmune disease. Natural sources of foods rich in carotenes which give apricots, melon, pumpkin, butternut squash, carrots tomatoes sweet potatoes, papaya, red and yellow peppers and mango their orange pigment, have been especially beneficial in vitiligo. These red/yellow vegetables and fruits contain Beta carotene – which converts to vitamin A – important for mucosal and skin health – lowered levels of vitamin A are shown in those with vitiligo hence increasing the risk off ROS damage to vitiligous melanocytes.
As previously discussed, abnormal microbiome can create inflammation and cause intestinal changes and discomfort, triggering an immune response. For those not sensitive to fermented foods – the probiotics from fermented food choices can help repopulate the microbiome by encouraging the growth of good bacteria in the gut. Organic Greek yoghurt or sheep’s yoghurt is a great choice to start with. For those focusing on more plant-based options, there are now fermented nut yoghurt alternatives which may be helpful.
Other fermented foods include: kimchi, sauerkraut, kefir, tempeh, kombucha.
Note: Monitor your symptoms as this can trigger gas and bloating for those in need of gut support in which case work with a registered practitioner.
CHOOSE ORGANIC AND GRASS-FED MEATS
Choosing organic minimises toxin exposure from herbicides and pesticides used during commercial farming. When choosing meats, opt for grass-fed instead of grain-fed to ensure the animal has not been fed an inflammatory grain which could up-regulate inflammatory processes. Also, consider reducing the amount of meat you consume due to its pro-inflammatory response on the body.
Fibre is full of anti-inflammatory compounds in addition to providing nourishment for commensal bacteria. Good bacteria in the gut also ferment fibre to produce metabolites like short-chain fatty acids (SCFA’s) which are the main source of energy for the cells that line the colon. SCFA’s can curb glycemic response and satiety, promote weight loss, enhancing mineral absorption, reducing systemic inflammation, and improving intestinal health.
Omega-3 fatty acids modulate the genes for inflammation in many different areas of the body and it is essential that our intake of anti-inflammatory omega-3’s exceeds our intake of pro-inflammatory omega-6’s.
Foods rich in omega 3 including leafy greens, walnuts, flax seeds, organic chicken organic eggs and oily fish (e.g., Sockeye Salmon, Mackerel, Anchovies, Sardines, Herring). Historically we consumed more omega 3 in ration to omega 6, however with the modification of the Western diet, this ratio is now higher in pro-inflammatory omega 6.
NUTS AND SEEDS
Naturally rich in vitamin E, zinc and selenium which are important for melanin production and offer antioxidant support to counteract oxidative stress. They are rich in protein, health fats vital for cellular function, vitamins and minerals as well as omegas. Be sure to opt for unprocessed versions and not those coated in salt and sugar.
These are just some dietary changes that can easily be implemented, before transitioning on to a more personalised approach. In addition to diet; lifestyle also play a huge role in autoimmunity and it is imperative that this also receives attention. Walks in nature, yoga, Pilates, more physical social engagements with people and not over social media are all ways to support your stress hormone levels.
FOOD MYTHS IN RELATION TO VITILIGO?
What we eat, and drink has no effect on vitiligo?
When I was diagnosed with Vitiligo, the first question I asked the consultant was, “is there anything I can do to support it”? Back then my comprehension of diet and lifestyle was very conditioned towards fad diets consisting of low fat and calorie restricting so didn’t make the connection that nutrition and lifestyle measures determine health – for me I could not see beyond an aesthetic correlation to look in a certain way. So when I was told “no, food had nothing to do with it” I easily accepted this answer.
Fortunately, as the years have progressed we are moving towards a culture of understanding the notion, yes, the food we do and don’t eat and our environment is actually affecting health and wellbeing including mental health issues. We now have evidence to suggest removing the western diet of highly processed foods, saturated fat, refined sugars and lack of fibre and food diversity, has a detrimental effect on our immune system and chronic disease including autoimmunity acerbation.
There is much correlation between the gut health and microbiome of those with autoimmunity and the prevalence of the effect it has upon being in remission.
When taking supplements, it is imperative to work with a nutritionist or clinician as over dosing in supplements can have a serious effects on our body as well as having contraindications with pre-existing medications.
VITAMIN B12 AND FOLATE
Folate- In comparison to the general population, people with vitiligo show to have lower serum levels of folic acid. It is thought individuals with vitiligo have higher levels of ROS which can affect the melanocytes inducing the depigmentation. Low serum levels of B12 were also significant in these studies. Combined with folate and controlled sun exposure induced re-pigmentation for 64% of the patients participating in a meta-analysis study.
Considering a high strength B vitamin may offer promising results in both energy production and in some cases pigmentation.
Vitamin C is important for collagen production. Being a water soluble vitamin, there is no toxicity associated with larger doses whilst it can cause looser stools if you have exceeded more then you need. In patients with vitiligo, alongside UV-B therapy showed re-pigmentation, albeit it is still an important vitamin to include to reduce oxidative stress even if you do not receive UV-B therapy. Since our body cannot manufacture vitamin C – it relies to get its source from food primarily fruits and vegetables. Alongside nutritional means, supplementing with 1-2 g split three times a day is recommended.
The liver and kidneys convert vitamin D (produced in the skin and taken up in the diet), into the active hormone, which is called calcitriol. Active vitamin D helps to increase the amount of calcium the gut can absorb from food into the bloodstream and also prevents calcium loss from the kidneys.
It is estimated that ultraviolet-B (UV-B)-induced production of vitamin D on the skin accounts for about 80% of vitamin D supply, whereas dietary intake (e.g. fish, eggs or vitamin D-fortified food) plays minimal effect. In colder climates like the UK, this is highly unlikely to be produced in sufficient amounts so monitored supplementation is recommended – especially as we have morphed into more indoor sedentary beings. Vitamin D is a fat soluble vitamin – meaning our body has the ability to store amounts in our body – so testing prior to starting is recommended to prevent over dosing at toxic levels.
Low vitamin D levels are associated with chronic inflammatory conditions. In optimal levels, it inhibits autoimmune responses by regulating T- cell activation. Furthermore, numerous studies have associated lower levels of vitamin D with those who have vitiligo – many of the participants which carried a genetic polymorphism of Vitamin D receptors – meaning these individuals were unable to uptake Vitamin D. Vitamin D has also shown promise with gut microbiome and gastrointestinal health alleviating gastrointestinal symptoms – supporting its importance in immune support and autoimmunity.
Gingko Biloba is a herb thought to have immunomodulatory effect on the body as well as being an antioxidant.
Whilst the direct mechanism is not fully understood for why Gingko shows positive effects on vitiligo, Ginkgo is known to have anti-inflammatory, immunomodulatory, and antioxidant properties. Ginkgo has shown consistent results in supporting anxiety which is often associated with vitiligo. Six studies reported cessation of spread of vitiligo, one of which showed that ginkgo biloba was more than twice as likely to stop vitiligo spreading than placebo.
MENTAL HEALTH AND WELLBEING
There is now compelling evidence to support how a range of lifestyle factors are involved in the pathogenesis of depression. Several nutritional deficiencies also associated in vitiligo such as vitamin B12, folate (B9), and zinc, can cause symptoms of depression, low mood, fatigue, cognitive decline, and irritability. Dietary patterns high in processed foods, or a “western dietary pattern,” are strongly correlated with an increased risk of developing depression and mild cognitive impairment.
Furthermore, the research continues to grow around the microbiology of our gut. Finally, probiotics are making headlines and for good reason. There is strong clinical research with the connection of not only with correlation of probiotic use in autoimmunity, including vitiligo – but also on the positive effects of probiotics upon mental health issues like depression.
Whilst there are many anxieties and insecurities with health and disease, the visual appearance of vitiligo can often heighten feelings of social isolation where medication is often the first line of treatment. “Lifestyle Medicine” provides a nexus between public health concerns and clinical treatments, which involve the application of nutritional, environmental, behavioral, and psychological principles to enhance physical and mental wellbeing. Modifying towards these changes has anecdotally shown life changing results and warrants further studies to potentially work alongside primary healthcare modalities.
MY TAKE AWAY POINTS
Manage stress levels – Engage more with social activities that make you feel alive. Do things for self-care and activities which give you time to be away from your stresses. Vitiligo and autoimmunity has been linked as a stress response to the melanocytes.
Remove or limit free radical damage or ROS drivers from your diet and environment – Individuals with vitiligo have been reported to have compromised antioxidant responses.
Replace the western diet with rich antioxidant foods and build nutritional status with the help of a registered practitioner to help you identify your triggers, drivers and importantly how to manage your condition.
Be kind to yourself. We live in a world where there is room for everyone to be just as they are. Reach out to people who are in similar situations, which can allow you to support each other. Support networks can be a fun and inviting way to just be yourself which can be freeing. Let that build your confidence to embrace all that you are, as you are.
Remember – our body is a whole and interconnected. Vitiligo is not an isolated condition – as with anything – it is part of a bigger picture.
The information provided is for educational purposes only and should not replace medical care nor should it be used as diagnosis or treatment purposes. Please be sure to always consult your healthcare provider or seek medical attention should you have any concerns with your health.