Vitiligo: Autoimmune Silent and Overt Celiac Sign

(Picture courtesy: wikipedia)

At my children's elementary school, I'd conservatively estimate that at least 25% of the children have vitiligo the skin condition that the late Mr. Michael Jackson suffered from (or...self-induced?) that caused loss of skin pigmentation (melanocytes). Small patches of whitish areas on their tan or darker-toned faces are the tell-tale signs. I'm not a dermatologist but this is easy to diagnosis. Vitiligo is yet another autoimmune disease with high association with several HLA immune types which leads to destruction of target cells (T-cell cytotoxic lymphocyte destruction of skin melanocytes). This condition is obviously more apparent in darker-skinned individuals (like my daughter) of Asian, African, Indo-Asian and Middle Eastern descent but paler-toned individuals who have a risk of melanoma can also share the same pathology.

Common treatment is immunosuppressants which dampen the body's own immune responses. In fact we were given steroid creams to apply to the lightened spots on my daughter's face. Does these work? Perhaps for some, but in our case, none worked and we ended up just giving up. We had been on vitamin D (which cured hers and my intermittent asthma) and omega-3s for half-year but noticed no real changes on the white spots until we went gluten-free. Yes, apparently I've ruined my daughter's life since we stopped wheat and gluten (we are the 'weirdos' in her school and understandably she's horribly embarrassed).

The trade-off for ruining her life? Within 4wks of our family going gluten-free, her skin toned completely evened out and ALL the few mild white spots disappeared. Now they only re-appear to a limited extent if my babysitter tries to toxify her or if we give in to her whining for wheat.

Where did vitiligo come from?? Neither my parents or my in-laws have ever been affected by this skin condition? It's not contagious. It's inherent in the DNA.

My parents are Hakka and their ancestors grew up for hundreds of years on the Pacific-Rim island, Taiwan. They grew up eating grains like rice (which is of course non-gluten containing) and had very little wheat or flour products. With the Japanese occupation their diet in fact probably improved -- consuming more miso (fermented soy bean), varied seafood, dried small fishes, buckwheat (again not gluten), etc. Growing up we ate sashimi from a young age and rare little bread or cereal (except the little breads for succulent roasted Peking duck at restaurants). As kids we snacked on dried cuttlefish and glutinous rice balls made with Pork or Fish Sung (see picture, courtesy of wikipedia). Pemmican is a shredded, dried meat like flaked jerky eaten by native American Indians. Our Asian/Taiwanese version is Pork and Fish Sung (with a little added sugar... HHHhhhMMhh.... and lots of LARD... yum). A frequent staple was pork spareib/bone soup with seawood, mushrooms, certain Chinese berries (ginko)/nuts, and bamboo shoots. It is pretty neat imo how many ethnic foods coincide in derivations and are just mutations of the 'Paleo' diet. I don't eat much sweet potatoes but my parents love that stuff. The shape of Taiwan's geography resembles a sweet potato and it's considered one of the national foods. (I do like yam noodles which are slivery smooth and delicious and very high in protein but I think those are more Korean.) Interestingly, traditional Japanese and Taiwanese dishes are incrediblely Paleo... with the exception of the ubiquitious rice...which probably explains the extreme myopia and short stature of meat-seafood-deprived parts of Asia (btw I'm not myopic or short since I grew up here in NE, PA and Cali eating like the carnivore/omnivore that my parents raised... quite frankly, my sisters and I are Amazonian in height/size relative to all of our *wink* vertically-challenged relatives and Asian friends...some... who forbid me to wear platform high-heels near them *haa*).


FYI... Below is an excerpt from the WSJ of what modern Taiwanese eat -- many cook traditional Japanese foods like my parents.

"...much of what you find in Taiwan that's truly Japanese is a relic of sorts from its days as a colony of the empire of the sun. From 1895 to 1945, Japan occupied Taiwan and the nearby Pescadore Islands -- its spoils of victory over the Chinese in the Sino-Japanese War (1894-95). During that time, the Japanese turned an agrarian backwater into one of the most modern -- and well-educated -- societies in Asia.

The Japanese built grand public buildings, turned the harbors of Kaohsiung and Keelung into key shipping ports, and laid a railroad that stretched along the western coast of the island. In Taipei, they tore down the old city walls and built a grid pattern for the city's streets. Eventually, they extended primary education -- in Japanese, of course -- to ordinary Taiwanese, an effort to nurture literate workers."

Another article appeared highlighting restaurants that serve traditional Japanese fare in popular hot spots in Taiwan in the WSJ today.... My mouth is watering!

"After the Japanese defeat in World War II in 1945, the Chinese reclaimed the island... But the rebranding of Taiwan, which continued after the Nationalists fled the Chinese mainland in 1949, wasn’t entirely successful. There are many Japanophiles living in Taiwan, and many places offering tourists in Taipei a less-expensive alternative to a trip to Japan. The roots of Japanese culture are still on display in Taipei, in a warren of alleys that locals call “Little Tokyo,” just south of Nanjing Road.

Today, these alleys are virtually indistinguishable from Tokyo’s Kabuki-cho nightlife district, lined with brightly lit Japanese signs advertising countless tiny hostess bars hidden behind doors not quite thick enough to contain the warbling of off-key karaoke. At the bar, you’re likely to find groups of middle-aged salarymen similar to those you’d see in Tokyo, except the hostesses—sitting beside them and keeping the drinks and conversation flowing—speak Japanese with a Taiwanese accent.

The Japanese-style grilled eel at the restaurant Fei-qian-wu is far better than its bar-alley location would suggest. The smoky flavor of the eel counters the slightly sweet basting sauce, just as you’d expect in Tokyo’s finest unagi (grilled eel) restaurants.

As at most casual eateries in Japan, the menu at Fei-qian-wu hangs on plaques around the walls (laminated menus in Chinese and English are also available). Order in Japanese or Mandarin—the restaurant was founded 35 years ago by a Japanese-Taiwanese family. You won’t even find the ubiquitous Taiwan-brand beer here. Instead ale drinkers are expected to order Kirin. A regular size unajyu (grilled eel over rice served in a lacquered bento box) and a Kirin costs about $6, a small fraction of the several thousand yen you’d expect to pay at an eel restaurant in Tokyo.

It’s not just the physical manifestations of Japanese culture that survive. Taiwan is one of the few places that can successfully duplicate the tipsy camaraderie of an izakaya eatery, where Japanese kick back and relax over drinks and small dishes of food after a hard day at the office.

At Wa-ko, the specialty is fresh seafood, and it offers an excellent variety of sashimi and grilled fish, served in small portions to go with drinks. Like most izakaya joints, the restaurant has two rooms: one with tables and chairs, the other with pillows or low-benches around tables in sunken recesses—old-style Japanese. On a recent visit, the traditionally styled room was full of Taiwanese customers. Owner Asato Satoshi, 55 years old, hails from the southern Japanese islands of Okinawa, and opened Wa-ko nearly two decades ago. The most popular dish is an Okinawan xia jiu cai—tofu with small fish and lemon on top. Be sure to try the roast chicken wings and squid with tarako, a kind of fish roe.

Oden is so much a part of Japanese food culture that a steaming pot of the stuff can be found right next to the cash register in many Japanese convenience stores. A simple, lightly flavored broth with root vegetables, egg, tofu and fish paste, oden dates back hundreds of years. Besides the modern convenience-store variety, oden traditionally was consumed at sidewalk stalls, along with the requisite glass of sake or beer, as a late-night snack. Taiwan sports its own homegrown version of oden bars—called heilun in Mandarin—that date back to its occupation-era days, and it has some traditional Japanese versions as well."

Gene expression skipping between generations? What promoted the sudden gene expression of vitiligo when in previous generations it had not appeared (as far as I am aware)?

Well... I don't need to go far... I just look in the mirror. *haa* In utero wheat intoxification probably caused triggers for my poor little helpless offspring. I remember doing the prescribed Pedi progression of starches... rice meal... oats... barley meal (ding ding... GLUTEN)... then of course wheat. Like Martha Stewart, I did produce some good food processed homemade lamb stew baby food and other tasties... but at daycare she received the usual gluten/wheat drivel like goldfish crackers, hearthealthywholegrain-Cheerios, mac-n-cheese, cookies, etc. We provided our share of wheat as well. I only hope now we can make repairs and prevent damage to her children and their grandchildren... Certainly I'm in awe of the power and scope of epigenetics and yet... completely horrified.

Horrified.





I have been seeing an older 70-something year old gentleman with all 3 diabetic complications -- retinopathy, nephropathy and neuropathy. High Lp(a) and vitiligo exist as well. Lp(a) progressess ALL diabetic complications -- specific organ damage, microvascular disease as well as macrovascular disease of the coronary, peripheral and renal arteries. Tissue and cellular damage all occur faster, deeper and harder. He declined insulin (which is good b/c Lantus insulin is now associated with a 31% increased cancer risk). Therefore, at visits we hammered and hammered the diet and negotiated a few vitamins. He was already very active spending most days working around the house and helping his wife with grandchildren.

New diet:
Breakfast -- 3-6 eggs, bacon occ (nitrate free, organic), menudo (no starches, no hominy, no corn)
Lunch -- salad with protein and olive oil
Dinner -- protein, little starch (yams, few small potatoes (no corn tortillas which are all contaminated with flour/wheat; no bread)

Nutrional Deficiencies and Correction:
Magnesium 2-4 daily (all Metabolic Syndrome are depleted)
Taurine (in 3mos -- this + glycemic control resolved all diabetic neuropathic pain symptoms and lowered BGs and BPs; he stopped Neurontin, Actos and cut BP meds by half)
Omega-3: BOATLOADS of EPA DHA 6-8 g daily (for Lp(a), insulin resistance, autoimmunity, PVD, etc)
Vitamin D to achieve 25OHD 70 ng/ml
Vitamin A for skin and deficiency
Slo-niacin (vitamin B3 -- vitiligo a sign of Pellagra? Perhaps Y-E-S) 500 mg/d and gradually titrated to 1.5 g/d over sev mos


After 3-6 mos, the Creatinine (kidney measurement) improved from 1.5 to 1.2 (maybe better now -- that was 12/08), BP reduced from 160s/80s to 116/60s, HDL increased from 33-35 to 48 mg/dl (again probably better now -- 12/08 labs), he lost 4-6 inches on his large expansive belly, and his sugars were well controlled (no insulin EVAH; last a1c 6.9% from 8%). In fact, the oral medications have all had to be cut back (Prinzide, Norvasc, Glipizide); Actos and Neurontin entirely stopped. Simvastatin 20mg cut back to once weekly... yeah... the dose: a couple licks of the tablet once a week. He also conceded that he felt younger, more energetic and glad for the diet changes. We actually had some ... ummm... disagreements for the first 3 mos! He brought his daughter on two occasions to articulate his displeasure and frustration with the new meal plan. Didn't work. *evil laugh* We ended up hammering the diet with his daughter as well, much to his general disgust. Giving up food he had been eating for 70+ yrs was ahhh... let's say DIFFICULT.

Results? Standard.



Mild vitiligo on his face completely disappeared.

The extensive vitiligo on his hands and fingertips (similar to the wiki picture posted above) stabilized and did not worsen. Skin become sealed, soft, and smooth.

He attended several large family reunions and get togethers and he reported to me that many were shocked and surprised... they told him he looked so much younger. He told me that he doesn't miss eating corn, rice, bread, oatmeal or tortillas. Or upset that he has to wear suspenders to keep his pants from falling off of his tight skinny little *ss... (ok latter's my clinical assessment and physical evaluation... *ehe*).



References:

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