Why is sleep so important?

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Can’t fall asleep.. my mind is too active! Does this sound familiar? How about ‘I woke up and I can’t go back to sleep!’… or tossing and turning all night?.. or ‘scratching my itchy skin is keeping me awake!’

Sleep is a fickle thing. Vital for recovery and recharging of our vital energy, it all too often eludes us, eroding our energy levels, adding to our stress.

Why is sleep so important?

Sleep is the time where we allow the body to rest and recover and repair itself. Sleep is essential for overall wellbeing, stress management and skin health.

Many skin conditions adversely affect sleep, this may be due to persistent itching and scratching at night, burning and hot skin, discomfort due to dry skin and pain and so on.

Stress is a big enemy of sleep, and sleep quality is often a good indication of how well stress is managed. Typically, in times of high stress, we may have difficulty in falling asleep (sleep onset insomnia) or waking in the early hours of the morning and not being able to return to sleep (sleep-maintenance insomnia).

All too often these factors lead to a vicious cycle where stress results in poor sleep, which results in skin condition flares, which exacerbates poor sleep, which results in fatigue which results in higher stress and a worsening skin condition, which leads to even worse sleep and higher stress and so on.

So how do we tackle this conundrum?

Well, first we need to look at improving whatever is interfering with our sleep. If it’s a skin issue, it’s time to work on that problem and get the itch and discomfort down. If there’s stress, work on the stress using good stress management techniques and improving nutrition so we have the nutrients to counteract the effects of stress.

If sleep is just fickle for no reason, it’s time to look at sleep hygiene

Sleep hygiene

These are effective steps we can take to improve the quality of sleep.  As with all things, it is worthwhile to persist with these steps, and within a few weeks, they should be making a big difference.

  • Try to maintain regular sleep patterns, for example, go to bed at 10 and rise at 6, try not to deviate from this routine.
  • Use your bed for rest only – not eating, or watching TV, or using your phone
  • Avoid day naps as far as possible
  • Consistent night time routine – wind down before bed – switch off mobile devices an hour before bed, warm bath, dim lighting, read a book and so forth
  • Make sure the bedroom is quiet & decluttered bedroom, a calm space
  • Make sure the bed is comfortable, clothing is light and comfortable, pillows are comfortable
  • Regular exercise is important for health.  Exercise should be a few hours at least before bedtime to avoid overstimulation
  • Use relaxation techniques before bed
  • Avoid stimulants and diuretics – alcohol, drinking coffee in the afternoon, sugary snacks after dinner
  • Temperature control – keep the temperature cool in the bedroom, wear light comfortable clothing, and avoid heating/ spicy foods at dinner time.

Phillip Bayer

Senior Practitioner, Psoriasis Eczema Clinic

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Stress and its relationship to the Immune system

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 Stress has very much become a part of life with most of us functioning under moderate to very high stress most of the time during our working lives. The impacts of significant stress are far-reaching and affect all aspects of human health. Chronic stress is a less intense, longer lasting form of stress than acute stress, which over time, is associated with increased ‘wear and tear’ on body systems and quality of life.

Since the dawn of mankind, through the process of evolution, the human body developed mechanisms to protect itself during periods of stress. Known as the ‘fight or flight’ response, these mechanisms are designed to save our lives in dangerous situations. The problem in modern times is that stress has become much more continuous and frequent, and therefore these normal physiological responses to stress are frequently or continuously affecting us, which results in health problems.

Often overlooked are the damaging effects of high stress on the immune system. Stress poses a significant risk to immune health, as it results in increased inflammation, decreased number and function of immune cells, and disrupted immune system balance.

The outcome of this impact may result in a health condition, such as cancer, skin conditions such as atopic eczema & psoriasis, recurrent infections, diabetes, cardiovascular disorders and auto-immune conditions.

In addition, chronic high stress or a sudden stressful event is also very often involved in a flare of an existing health condition.

Very often, your body will show physical signs of high stress when the threshold of acceptable stress has been crossed. These signs may include:

  • Fatigue
  • High blood pressure
  • Reduced libido
  • Sleeping difficulties – such as difficulty to fall or remain asleep
  • Weight gain around the middle
  • Cravings for caffeine or sugar
  • Muscle aches/pains/twitching
  • Frequent headaches
  • Frequent infections
  • Low moods/ feeling flat/ inability to enjoy life

If there is significant stress, it is vital that the stress is addressed and its effects decreased in order to reduce the effect of this enormous driver for health issues.  If the source of stress itself cannot be eliminated, and usually it cannot, then we need to consider ways to mitigate and reduce the effects of the stress on the body.

This is where effective stress management strategies need to be implemented and adhered to in order to help with your health concern.

In more serious cases of acute or chronic stress, such as abusive relationships, addiction, clinical depression, PTSD and anxiety, professional help is required. Helplines such as Lifeline (www.lifeline.org.au Tel: 131114) can offer support and guidance if needed.

The practitioners at Psoriasis Eczema Clinic can assess all the triggers for your skin condition and can advise you how to address these triggers.

 Phillip Bayer

Senior Practitioner, Psoriasis Eczema Clinic

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Stress Management

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The Importance of stress management

Stress is an intrinsic part of living in today’s world. There are times when we all go through acute phases of stress that are relatively short lived, and somewhat manageable as we know that it will pass. Living with chronic stress has an insidious effect on our overall health and can be responsible for many illnesses we experience today. Our mental and emotional wellbeing can also be affected as the stress begins to wear us down.

Learning how to look after yourself during times of stress is imperative in minimizing the overall negative effect it has on your system as a whole. This becomes extremely important when a pre-existing illness is present, as the additional stress can escalate symptoms and worsen the condition.

The next few blogs will discuss some easy to implement techniques for feeling less stressed, more relaxed and peaceful, as well as some dietary tips to increase your energy levels and prevent illness.

 

Recognising symptoms of stress

Short term or acute stress is fairly easy to recognise. These physiological responses come from the adrenal gland where adrenaline is released upon perception of a threatening situation.

Some of the symptoms you will want to be aware of are:

Rapid or shallow breathing

Increase in heart rate and blood pressure

Nausea – due to inhibition of digestion. Blood flow is redirected away from stomach, can also cause a nervous feeling in the pit of the stomach

Dry mouth

Trembling or shaking

Increased blood flow to skeletal muscles

Cerebral blood flow is reduced, and rational thought is compromised.

Increased alertness or agitation, “knee jerk” reactions and instinct become prevalent.

Dilation of pupils

When these sensations begin to be felt it is now time to take evasive action to minimize the elevation of the situation on an emotional and physiological level.

 

Chronic Stress and its consequences

Stress is a natural transient state for all human beings. We are designed to be able to activate survival mode whenever a perceived ‘life threatening’ event occurs. We are designed to be able to escape this event by utilising the enhanced physical capacity we temporarily have. What if there is a constant bombardment of perceived threats throughout the day, what happens to us physiologically when that energy isn’t utilised to physically fight or flight (run). Our nervous system isn’t designed to cope indefinitely with this pattern, so a different defence mechanism is utilised by the body and different hormones and effects will occur.

When we switch into a long term stress pattern, the main hormone the body utilises for ‘survival’ is cortisol. That is not to say that we no longer produce adrenaline, if the stress is bad enough, we can be pumping that out as well. Cortisol is designed to protect us in long term stress as the body’s wisdom dictates by this stage we must be injured or in some dire physical state.

So what does cortisol do to the body? Or in other words what are the signs of chronic stress?

It is now believed that Cortisol is responsible for immune dysregulation. What this means is that there are mixed messages for the body’s immune response – it may switch off the part of immunity that is responsible for monitoring and eliminating infections, which is why we can become sick more often or can’t seem to fight off a common cold. The immune system may go into a hyper state as well which means it can be so primed that it actually starts to attack even our own tissue which leads to inflammation. This is where if you have a chronic condition such as arthritis or any sort of autoimmune disease, the symptoms will worsen when you’re stressed.

Cortisol also increases insulin output under the assumption that if the body has been in a state of constant physical threat then the body must need more glucose in the cells to be able to have the energy to sustain itself. The net result of increased insulin is weight gain,(especially around the gut), sugar or carbohydrate cravings, and fatigue.

Cortisol is at its highest in the morning – one sign of long term stress or ‘adrenal fatigue’ is feeling absolutely wiped out and tired with difficulty getting out of bed first thing in the morning. As the day goes on you may notice a peak in energy around 5:00pm and then go to bed exhausted but unable to sleep. This is a common pattern.

Cortisol also increases risk of heart disease, and promotes premature ageing. CRH is the hormone that switches on Cortisol release. CRH also has an impact on the body such as increasing pain perception, and also affects bowel function.

The long term effect of elevated stress hormones will also have an effect on the brain, and reasoning and emotional control will also be affected. Many people that have been coping with stress long term will find their ability to focus and concentrate on tasks is diminished. They may also experience mood swings, frequent weeping, or poor anger control.

The above symptoms illustrate why it is so imperative to learn to recognize the symptoms of stress, and its progression into a chronic state. This needs to be addressed and corrective measures are put in place. Allow yourself some time to practice the suggestions in the followings blogs and be patient with the process.

Smiling Mind offers a free guided meditation app: https://www.smilingmind.com.au/smiling-mind-app/

Stress & The Effects on the Skin

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It has been established in recent years that the skin is a direct target of psychological stress via a cascade of hormones, neuropeptides, and neurogenic signals (causing nerve hypersensitivity and inflammation). The skin has been shown to be capable of launching its own local response to stress as well by producing many of the same substances that the brain produces, further enhancing the local effect at the skin level when someone is under acute or prolonged stress. It is no surprise that the skin can perceive and respond to stress similar to the brain and nervous system, since the two systems have evolved from the same germ layer during embryonic development.

The main skin cells (keratinocytes), mast cells (involved in allergy type reactions and inflammation), immune cells, and peripheral nerve endings all will have an effect on various cell behaviour and processes within the skin under stress that can lead to skin disruption, premature ageing and disease development.

The skin is rich in nerve endings, so when an individual is stressed the peripheral nerve endings secrete numerous substances such as Substance P and Nerve growth factor that contribute to hypersensitivity, inflammation, and allergic reactions.

Due to the impact of stress related hormones and peptides, and growth factors on the skin, stress can play a role in the development and exacerbation of skin disorders such as Eczema, Acne, Psoriasis, and Rosacea.

Psychological stress activates the autonomic nervous system to trigger release of catecholamines [e.g. epinephrine and norepinephrine] from the adrenal glands, and in situations of chronic stress corticotrophin releasing hormone [CRH] and ACTH (adrenocorticotropic hormone), mediate a release of glucocorticoids (Cortisol) from the adrenal cortex.

Here is a brief outline of some key stress mediators and the effect that they have on the skin:

Glucocorticoids:

Excess levels can cause atrophy and impaired wound healing by interfering with keratinocyte and fibroblast function. Keratinocytes are the primary skin cells that form the epidermis of the skin, and fibroblasts are responsible for collagen and elastin formation.

This manifests as atrophy and thinning of the skin, increased trans-epidermal water loss related to disruption to the skin permeability barrier, and easy bruising with impaired wound healing.

The skin barrier is also negatively impacted by excess cortisol as this effects the lamellar bodies in the skin cells which are responsible for lipid synthesis; the lack of essential lipids weakens the barrier resulting in dry skin, allergies and sensitivity, delayed healing and infections.

Insulin:

Excess glucocorticoids stimulate Insulin production and lead to insulin excess and Insulin resistance. Elevated Insulin stimulates IGF2 (Insulin growth factor) which increases growth of keratinocytes, and stimulates abnormal keratinocyte growth, (exacerbates Psoriasis and Acne) and increases androgens and testosterone release.

Substance P:

This is neuropeptide released in times of stress. Substance P stimulates sebaceous germinative cells and proliferation of sebaceous glands which results in excess oil production and blockage of the oil ducts and the development of acne. Substance P also activates mast cells, increasing histamine release and itch sensation. Substance P induces vascular permeability and inflammation, which aggravates conditions like Eczema and Rosacea.

Corticotropin Releasing Hormone (CRH):

CRH stimulates release of MSH (melanocyte stimulating hormone) causing hyperpigmentation and blotchy skin.

Catecholamines (Adrenaline, Noradrenaline)

Decrease blood perfusion to skin reducing availability of oxygen and nutrients resulting in poor texture and sallow / pallor. Catecholamines have also been shown to cause immune suppression, interfere with DNA repair and contribute to ageing.

Managing stress

While the effects of stress on the skin are only briefly outlined above, it illustrates the significant impact this can have on individuals predisposed to skin conditions. It is therefore imperative to minimise stress where possible in order to avoid any exacerbation of skin disorders.

There are some straight forward tips to reduce stress such as getting a good night’s sleep, exercising and following some simple dietary guidelines (listed below).

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Reduce salt intake

Avoid alcohol

Avoid caffeine

Avoid skipping meals

Avoid refined, processed foods.

Avoid high fat foods

Do eat high fibre, low glycaemic index diet

In the following blogs we will present some relaxation techniques that are easy to implement and will have a direct effect in reducing the side effects of stress.

 

References

  1. Dunn, Jeffrey HKoo, John; Psychological Stress and skin aging: A review of possible mechanisms and potential therapies; Dermatology Online Journal 19 (6): 1 University of Colorado, School of
  2. Medicine, 2 University of California, San Francisco, Department of Dermatology 2013 Permalink: http://escholarship.org/uc/item/3j0766hs
  3. Jessica M. F. Hall, desAnges Cruser, Alan Podawiltz, Diana I. Mummert, Harlan Jones, Mark E. Mummert; Psychological Stress and the Cutaneous Immune Response: Roles of the HPA Axis and the Sympathetic Nervous System in Atopic Dermatitis and Psoriasis; Dermatology Research and Practice Volume 2012, Article ID 403908, doi:10.1155/2012/403908
  4. Ying Chen, John Lyga; Brain – Skin Connection: Stress, Inflammation and Skin Aging; Inflammation & Allergy – Drug Targets, 2014, 13, 177-190
  5. Theoharis C. Theoharides, Jill M. Donelan, Nikoletta Papadopoulou, Jing Cao, Duraisamy Kempuraj, Pio Conti; Mast cells as targets of corticotropin releasing factor and related peptides; TRENDS in Pharmacological Sciences Vol.25 No.11 November 2004

PSORIASIS and DIET – Part 1

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For many years Dermatologists, General Practitioner’s and many researchers considered that patients who stated that eating certain foods made their psoriasis  worse as being utterly mistaken or delusional. However, over the last several years there has slowly been a change of thought and we are now seeing the results of several recent studies and clinical trials on various nutritional and dietary therapies for psoriasis. And the results have made it clear that diet may influence the health outcome for patients.

A study of some 20,000 eczema and psoriasis patients by the Department of Medical Nutrition, Donau University Krems in Austria, found that the patients showed, besides allergic reactions to foods, an increasing number of pseudo allergic reactions caused by toxic-irritative pollutants (formaldehyde, exhaust particles, food additives, nicotine, wood preservatives, pesticides, heavy metals) which are responsible for the inflammatory process behind the complex symptoms. The Researchers found that 60% of all patients had raised concentrations of circulating immune complexes with food-specific IgE- and IgG responsible for the delayed (Type III) allergic reactions. They found that both in atopic eczema and in psoriasis patients had pseudo allergic  reactions against biogenic amines and had constantly raised serum histamine levels. Previously published results showed significantly reduced DAO activities in  thrombocyte rich plasma of atopic eczema and psoriasis patients explaining their intolerance reactions to histamine, tyramine and octopamine rich foods.1 Diamine oxidase (DAO) is an essential enzyme in the body that breaks down histamine. The body then takes the break-down products (called imidazole compounds) and excretes them through the kidneys into the urine.

Biogenic amines play important role in human body such as: regulation of body and stomach pH, gastric acid secretion, the immune response and cell growth and differentiation. At the same time, amines are important for the growth, renovation and metabolism of every organ in body and are also essential for maintaining the high metabolic activity of the normal functioning and immunological system of the gut. Despite these roles, the consumption of foods with high content of biogenic amines can cause adverse reactions such as nausea, headaches, cardiac palpitation, hot flushes, oral burning, gastric intestinal problems, renal intoxication, rashes and changes in blood pressure. Different biogenic amines can cause different side effects such as: excess tyramine intake could cause hypertension whereas serotonin is a vasoconstrictor. People having deficient natural mechanisms for detoxifying biogenic amines due to genetic defects or due to the intake of antidepressant medicines such as monoamine oxidase inhibitors may experience allergen-type reactions characterized by difficulty in breathing, itching, rash, vomiting, fever and hypertension. 2

Histamine is found in fermented alcoholic beverages, especially wine, champagne and beer,

bacon, salami, luncheon meats and hot dogs,  sour cream, sour milk, buttermilk, sour dough  bread, etc., dried apricots, prunes, dates, figs, raisins, citrus fruits, aged cheese – camembert, brie, blue vein and including goat cheese, walnuts, cashews, and peanuts,  avocados, eggplant, spinach, and tomatoes and smoked fish and certain species of fish: mackerel, tuna, anchovies, sardines.

Psoriasis is considered to be an autoimmune disease and in severe, uncontrollable psoriasis histamine antagonists are of value in reducing disease activity. Histamine formation and release raises the possibility, that histamine is one of the molecules involved in pathogenesis  of autoimmune diseases. 3,5

Tyramine is found in fava beans and tomatoes, broad beans, concentrated yeast extract spreads and bouillons, salamis and mortadella, beer as well as the above foods.

Tyramine, derived from tyrosine, mimics the effects of adrenaline, causing increased heart activity and raising blood pressure. Research has suggested that psychological stress can induce exacerbation of psoriasis. It is further hypothesized that these stress effects on the course and outcome of psoriasis are caused by neuroendocrine modulation of immune functions.4 Excess levels of tyramine releases adrenaline from storage vesicles.4,5 When chronic illness is involved and the body is in a state of chronic stress the adrenal glands begin to work overtime. Over a period of  time the adrenal glands begin to suffer from adrenal fatigue. Impaired adrenal function is associated with the incidence of autoimmune diseases such as skin conditions and arthritis.6

Octopamine is found in green bean, edamame (soybeans), avocados, bananas, pineapple, eggplants, figs, red plums, raspberries, peanuts, Brazil nuts, coconuts, processed meat, yeast as well as the above foods

Octopamine is closely related to the hormone norepinephrine, Researchers studying patients with psoriasis whose psoriasis is associated with increased levels of psychological stress, found that in the psoriasis patients there were significantly increased norepinephrine blood levels compared with non-psoriasis controls. The researchers concluded that there was a positive correlation between the severity of psoriasis and high levels of norepinephrine. 7

There has been a known correlation between Irritable Bowel Diseases such as Crohn’s Disease, Colitis and Irritable Bowel Syndrome (IBS or Leaky Gut), since the 80s. Some researchers have concluded that Psoriasis and IBD are strictly related inflammatory diseases, probably sharing immune-pathogenetic mechanisms. Skin and bowel represent, at the same time, barrier and connection between the inner and the outer sides of the body share similar immune processes which play a key role in maintaining homeostasis and in sustaining pathological processes. 8

 

Solanine is a glyco alkaloid  poison found in species of the nightshade family (solanaceae), e.g. potatoes, tomatoes and eggplant. It can occur naturally in any part of the plant, including the leaves, fruit, and tubers. It is very toxic even in small quantities. Research has shown that the disruption of epithelial barrier integrity is important in the initiation and the cause of inflammatory bowel disease (IBD). Solanine has been found to permeabilize cholesterol-containing membranes, thus leading to the disruption of epithelial barrier integrity. Altered intestinal permeability is believed by some researchers to play a key role in the initiation and propagation of the inflammatory process in conditions other than IBD.9,10  Solanine and related glycoalkaloids are classified as acetylcholinesterase inhibitors leading to increased levels of neurotransmitters which cause prolonged muscle contractions, pain, tenderness, inflammation and stiff body movement. Swollen joints are a clinical manifestation of synovitis and the acute-phase response act as bio marker of pro-inflammatory cytokine production. Solanine may also induce oxidative stress leading to generation of free radicals and alterations in antioxidant and scavengers of oxygen free radicals. 11 There is the potential for solanine to have an adverse effect on psoriatic arthritis. The percentage of arthritic patients who are sensitive to the solanine family of plants might be significantly greater than 10%. A 1982 study published in the Journal of the International Academy of Preventive Medicine demonstrated significant improvements in over 70% of 5,000 (> 3,500) arthritic patients after having eliminated solanine-containing foods from their diets.12

Also read our blog “PSORIASIS and COMORBIDITIES, PSORIASIS and ALCOHOL and PSORIASIS and WATER INTAKE”.

 

REFERENCES

  • Ionescu JG, Constantinescu R, Constantinescu AT; Personalized Anti-Inflammatory Nutrition For Atopic Eczema And Psoriasis Patients; EPMA Journal (2011) 2 (Suppl 1):S157–S165 DOI 10.1007/s13167-011-0118-6
  • Songül ?ahin Ercan, Hüseyin Bozkurt and Çi?dem Soysal ; Significance of Biogenic Amines in Foods and Their Reduction Methods; Journal of Food Science and Engineering 3 (2013) 395-410
  • Nielsen HJ,Hammer JH.; Possible role of histamine in pathogenesis of autoimmune diseases: implications for immunotherapy with histamine-2 receptor antagonists.; Med Hypotheses. 1992 Dec;39(4):349-55.
  • Schmid-Ott G. et al.; Stress-induced endocrine and immunological changes in psoriasis patients and healthy controls. A preliminary study.; Psychother Psychosom.1998;67(1):37-42.
  • Maintz and Novak N.; Histamine and histamine intolerance; Am J Clin Nutr 2007;85:1185–96
  • Physiology of Stress; Chapter 2; http://www.jblearning.com/samples/0763740411/Ch%202_S eaward_Managing%20Stress_5e.pdf
  • Ionescu G,Kiehl R; Increased plasma norepinephrine in psoriasis.; Acta Derm Venereol. 1991;71(2):169-70.
  • Skroza et al.; Correlations between Psoriasis and Inflammatory Bowel Diseases; Hindawi Publishing Corporation BioMed Research International Volume 2013, Article ID 983902, 8 pages http://dx.doi.org/10.1155/2013/983902
  • Patel B. et al.; Potato glycoalkaloids adversely affect intestinal permeability and aggravate inflammatory bowel disease; Volume 8,Issue 5, pages 340–346, September 2002
  • Shah S. Dietary Factors in the Modulation of Inflammatory Bowel Disease Activity.Medscape General Medicine. 2007;9(1):60.
  • Ayad S.K.; Effect of Solanine on Arthritis Symptoms in Postmenopausal Female Albino Rats; Arab Journal of Nuclear Science and Applications, 46(3), (279-285) 2013 27
  • Prousky J. E.; The use of Niacinamide and Solanaceae (Nightshade) Elimination in the Treatment of Osteoarthritis; Journal of Orthomolecular Medicine Vol 30, No 1, 2015