Nutritional Support

The Need for Supplements:

Almost every case of pemphigus is treated with prednisone, and a "steroid sparing" drug such as Imuran, which allows the dose of prednisone (a cortico-steroid) to be kept at a lower level to reduce the impact of side effects, which in themselves can create additional problems. Very few cases are treated without prednisone, although a combination of niacinamide and an antibiotic from the tetracycline family has been used to treat pemphigoid.

Although prednisone is effective in shutting down the immune system, and at the proper levels, capable of halting the blistering activity of pemphigus, it depletes a number of vitamins and minerals that are essential to overall health, and may slow the healing process if not replenished. Among these losses are the following:

  • calcium, a loss of which can cause osteoporosis.

  • vitamin D, which is essential for the absorption of calcium.

  • zinc, which is fundamental to the healing process, and the ability to tolerate stress.

  • folic acid, which is important to the process of making new cells.

  • vitamin C, the loss of which can lead to bleeding and bruising easily, hair and tooth loss, joint pain and swelling.

Since prednisone depletes these nutrients, it is necessary to restore them by taking vitamin and mineral supplements. Diet alone will not provide enough nutrients to lessen the impact. In addition to the symptoms listed above, a lack of zinc can cause depression, insomnia, anxiety, and mild to severe mental and emotional disorders, which are also associated with prednisone in some cases.

A level of calcium equal to 1200mg/day, along with 400 IU of D, is recommended by most doctors and nutritionists who are aware of the loss of calcium, and the potential risk of osteoporosis, that results from the use of prednisone. "Calcium/D" tabs can be found in most pharmacies and health food stores, and the latest recommendation is to take it in divided doses. There are many brands that contain 500-600mg calcium, and 200 IU's of D, in a single tablet, that can be taken twice a day.

The easiest way to ensure that you are getting enough zinc, folic acid, and vitamin C is to add a daily "stresstab" to your diet. The most popular brands, also available in pharmacies and health food stores, contain the following vitamins and minerals, with minor variations:

Vitamin C..............500mg
Vitamin E...............30 IU
Thiamin..................10mg
Riboflavin...............10mg
Niacinamide...........100mg
Vitamin B6.............5mg
Folic Acid..............400mcg
Vitamin B12...........12mcg
Biotin.....................45mcg
Pantothenic Acid....20mg
Calcium..................70mg
Zinc........................23.9mg
Copper...................3mg

A balance between zinc and copper is important. There are some brands of stresstabs that do not contain zinc or copper. That is misleading, since zinc is so important to our ability to handle stress, making it the most important element in a stresstab. It is possible to maintain an optimal level of zinc (between 22-25mg) by taking a multi vitamin, such as Centrum, which only contains 11mg of zinc, and adding a 10-15 mg zinc tab, or by taking Centrums twice a day.

An Exception:

Niacinamide is not one of the vitamins that is depleted by prednisone, but it is a very important factor in the way food is broken down in the body, and to what extent the vitamins and minerals we get from food are assimilated or absorbed. A severe lack of niacinamide causes a wide variety of disorders, and the vitamin has been used to treat arthritis (which is also an autoimmune disease), depression, alcoholism, anxiety, schizophrenia, and a number of related illnesses. It is almost always used with equal amounts of Vitamin C.

As a treatment for schizophrenia, niacinamide has been used to control hallucinations. Drs. Abram Hoffer and Humphrey Osmond discovered that under stress, schizophrenics produce a compound known as adrenochrome, which causes hallucinations. Stress leads to the release of adrenaline, which is a normal reaction, but in the schizophrenic, adrenaline is converted into adrenochrome, which can cause hallucinations. The schizophrenic "sees" things and "hears" things that are not there, and cannot distinguish between what is real and what is not real. Hoffer and Osmond knew that niacinamide, or Vitamin B3, can block the conversion of adrenaline to adrenochrome, and began treating their patients with large amounts of B3 (1000 mg or more, 3xday) along with Vitamin C, B1, B6, and E. To their credit, they chose only the most severe cases of schizophrenia, and were the first to admit their surprise when the treatment worked.

The importance this might have in the treatment of pemphigus lies in the knowledge that with pemphigus, the immune system appears to be seeing things too. It attacks healthy tissues and cells as if they were foreign to the body, and needed to be eliminated. It can no longer distinguish between "good" cells and "bad" cells, and begins to act in a very bizarre fashion, in much the same way that schizophrenics behave when they are hallucinating.

This idea might not seem so far-fetched, considering the work being done in a relatively new field of science and medicine known as "psychoneuroimmunology." Psychoneuroimmunology studies the relationship between the immune system, the mind, and the nervous system, which carries signals to and from the brain. To say that pemphigus is an "immune system disorder" may not be entirely accurate. The disorder does not necessarily begin with the immune system, but could have its origin somewhere farther up the line, or even as a result of miscommunications or misguided impulses carried over the nervous system.

Niacinamide is used as an anti-inflammatory agent when treating pemphigus, but it may turn out that what is really behind its effectiveness is its ability to counter the effects of stress and whatever hallucinatory compounds, such as adrenochrome, might be causing the immune system to act so erratically.

In orthomolecular medicine, niacinamide and C are used to treat a variety of illnesses, not as nutritional supplements, but as a means of correcting biochemical imbalances. The addition of niacinamide and C (500-1000 mg each, 3xday), along with a single 22 mg tab of zinc each day, might be useful when added to a conventional treatment plan for pemphigus. This approach would also be beneficial to people allergic to fillers, and ensure an adequate amount of zinc.

As a Supplemental Treatment:

The standard approach to pemphigus is to shut down the immune system, or limit its activity, using prednisone and other immunosuppressants. The treatment works, but not without a price. Some of the more common side effects include fatigue. aches and pains, depression, "moon face," etc., but these are only the outward signs of changes that are taking place on a much deeper level. By depleting some of the more important vitamins and minerals essential to good health, prednisone can alter our energy level, how we perceive things, the way we think and feel, and even lead to additional medical complications such as osteoporosis and diabetes. Although prednisone and the immunosuppressants are life-saving measures that cannot be ignored, they too are "foreign" to our natural biochemistry, and in some ways, in conflict with it. The use of supplements should not be considered an alternative or substitute for conventional treatment, but as a way of counteracting the serious nutritional deficiencies that can develop from long-term use of drugs such as prednisone. There is evidence to suggest that an adequate level of zinc, for example, might actually shorten the duration of conventional treatments, and lead to remission. For more information, click Here.

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