HEALTHY SKIN and WATER INTAKE – PART 1

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Water is an essential element for our existence as it performs a number of vital functions in the body.  It is a key component of the fluid that forms the basis of saliva that helps us to swallow, of synovial fluids that cushion the joints and of the fluids that fill our eyeballs and lubricates our eyes. It provides the medium for by which most of the chemical reactions in the body occurs, it acts as a cushion for the nervous system (cerebrospinal fluid), allows us to get rid of waste products principally via the kidneys and urine production, and helps to regulate body temperature by the process of sweating. 1,2,3

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The body tightly controls its water volume and, under normal conditions, the volume fluctuates by less than 1% per day. Dehydration can be defined as a 1% or greater loss of body mass due to fluid loss e.g. urine, eye lubrication, sweating, breathing etc. 1,2,3

Research experiments using fluid restriction to induce dehydration, has shown that loss of body mass of about 1% can be seen after 13 hours, about 2% after 24 hours and nearly 3% after 37 hours when no fluids and only relatively dry foods are consumed. It was noted, however, that the subjects undergoing fluid restriction had a strong desire to drink and would have been unlikely to become dehydrated to such an extent accidentally. These experiments do show how quickly body fluid loss can occur and the importance of continued rehydration by the consumption of water. 1,2,3

 If water losses are not sufficiently replaced, dehydration will occur and extreme dehydration is very serious and can be fatal. More mild dehydration (about 2% loss of body weight) has been shown to result in headaches, fatigue, increased stress/anxiety, reduced physical performance and cognitive function. Some studies have refined the level of dehydration, where detectable symptoms and changes occurred, to the following: in males, dehydration of 1·59 % body weight loss and in females   1·39 % body weight loss. Such modest loss in body weight can occur in everyday activities, demonstrating the importance of maintaining optimal hydration. Taking into consideration various changes attributable to factors such as ambient temperature, physical activity, state of health, the European Food Safety Authority has recommended that the appropriate water intake should be approximately 2 litres per day for women and 3 litres per day for men. Higher water intake requirements will, of course, be higher for athletes and those that are physically active in hotter climates.4,5,6  

The Stratum Corneum (SC) of the skin consists of the essential barrier between the internal and external environment. Although most of the skin is between 2-3mm (0.10 inch)  thick, the SC plays a vital role in forming a protective barrier and helps to prevent percutaneous entry of harmful pathogens (e.g. germs) into the body. In addition to serving as a physical barrier, the SC has other important functions, including the regulation of body heat (thermoregulation), respiration and maintenance of the body’s water content – transepidermal water loss (TEWL)   Stratum Corneum properties and its protective function can be modified by various internal and external/environmental factors.7

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So what happens to human skin when the body becomes dehydrated?

Any change in the structure of the stratum corneum (SC) is potentially associated with alterations of both its barrier function and water holding capacity. Decreased hydration with reduced elasticity of the stratum corneum is responsible for cracks and fissures in the skin. The rate of TEWL is higher in dry skin than in normal skin where the integrity of the barrier function is not disturbed. The impaired barrier in skin conditions such as psoriasis and atopic eczema makes the SC less efficient in excluding substances that come in contact with the surface and patients with skin conditions e.g. atopic dermatitis are believed to be more prone to contact dermatitis than a normal population and those with psoriasis more susceptible to flare ups after exposure to chemicals.8 

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How can you tell if you are dehydrated?

One simple test is to gently pinch the skin on your hand …. hold for a few seconds and then release the skin. If the skin springs back you are not dehydrated, if the skin remains tented (turgor) then it is a sure sign that you are dehydrated and need to drink at least two glasses of water immediately. Another way of checking is the simple observation of the colour of your urine when you go to the toilet. Some charts have numerous colour options but the simple chart that the NSW Government Health Department has on their website “Beat the Heat” is probably the best and easiest to use:-

REMEMBER IF YOUR URINE IS DARKER THAN THAT INDICATED THEN YOU ARE SERIOUSLY DEHYDRATED AND SHOULD ATTEND YOUR NEAREST HOPSITAL EMERGENCY DEPARTMENT

URINE COLOUR CHART

This urine colour chart will give you an idea of whether you are drinking enough water or you are dehydrated (lost too much water from the body)

 Very Dehydrated ……. DRINK 1 litre of water 
 Dehydrated …….. DRINK 2 -3 glasses of water 
 Somewhat Dehydrated ……. Drink 1 glass of water 
 Hydrated, You are drinking enough, continue drinking as normal

http://www.health.nsw.gov.au/environment/beattheheat/Pages/urine-colour-chart.aspx

 

Also read our blog “HEALTHY SKIN and WATER INTAKE – PART 2

 

REFERENCES

  • Popkin B. M. et al.; Water, Hydration and Health; Nutr Rev. 2010 August ; 68(8): 439–458. doi:10.1111/j.1753-4887.2010.00304.x.
  • Benelam B. and Wyness L.; Hydration and health: a review; Journal compilation © 2010 British Nutrition Foundation Nutrition Bulletin, 35, 3–25
  • Je´quier E. and Constant ; Water as an essential nutrient: the physiological basis of hydration; European Journal of Clinical Nutrition (2010) 64, 115–123
  • Ganio M. S. et al.; Mild dehydration impairs cognitive performance and mood of men; British Journal of Nutrition (2011), 106, 1535–1543 doi:10.1017/S0007114511002005
  • Armstrong L. E. et al.; Mild Dehydration Affects Mood in Healthy Young Women; The Journal of Nutrition Ingestive Behavior and Neurosciences; First published online December 21, 2011; doi:10.3945/jn.111.142000
  • EFSA (2008). Draft dietary reference values for water. Scientific Opinion of the Panel on Dietetic Products, Nutrition and Allergies, (agreed on 11 April 2008 for release for public consultation). (http://www.efsa. europa.eu/it/scdocs/doc/1459.pdf

PSORIASIS and ALCOHOL INTAKE

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The course of psoriasis is chronic and over a period of time the condition may be severe and commonly causes emotional problems, which in themselves may lead to relief drinking.1

Psoriasis Alcohol_1Patients with psoriasis experience considerable emotional distress, depression and social isolation due to the visibility of skin lesions, especially when the lesions are widespread and severe. Whilst it would be demeaning to state that all psoriasis patients with mild to severe psoriasis suffer from alcoholism, it has been confirmed in several Quality of Life studies that the percentage of psoriasis patients who admit to having a drinking problem may be as high as 32%. That said, the association between alcohol consumption and increased risk of psoriasis onset and psoriasis worsening has long been suspected.

Alcohol potentially weakens the immune response making psoriasis patients more susceptible to bacterial infections and injuries, which in turn can trigger and exacerbate psoriasis. Case studies have shown a definite connection between high consumption of alcohol and increased severity of psoriasis. Patients with severe psoriasis who misuse alcohol often show improvement after months of abstention or significant reduction in their alcohol intake. Patients who have abstained, improved and then gone on to have a binge drinking session, also experienced more severe flare-ups of their psoriasis upon resumption of drinking.1,2,3 It has also been shown that high alcohol intake is more problematic in the male population than in women.4

Alcohol_1Interestingly in a study of US women, researchers found that the risk for psoriasis varied according to the amount and type of alcoholic beverage consumed. “Non-light beer was the only alcoholic beverage that increased the risk for psoriasis, suggesting that certain non-alcoholic components of beer, which are not found in wine or liquor, may play an important role in new onset psoriasis. One of these components may be the starch-source used in making beer. Beer is one of the few non-distilled alcoholic beverages that use a starch-source for fermentation, which is commonly barley. This differs from wine that uses a fruit-source (grapes) for fermentation. Some types of liquors such as vodka may use a starch-source for fermentation; however these starches are physically separated from the liquor during distillation. Starch sources such as barley contain gluten, which has been shown to be associated with psoriasis. For example, individuals with psoriasis have elevated levels of anti-gliadin antibodies (AgA) and may have a so called ‘latent-gluten sensitivity’ compared to individuals without psoriasis.” 5

This is not to say that other forms of alcohol are then, by default, safe as vodka and other spirits have been shown to increase the severity of psoriasis in other case studies. Alcohol also in general should not be consumed whilst taking various anti-psoriasis medications such as Methotrexate, Cyclosporine, and Acitretin.6

Alcohol also affects the pituitary gland, resulting in reduced secretions of the anti-diuretic hormone that maintains the body’s proper hydration level. More specifically, the kidneys are no longer able to reabsorb sufficient water from your urine, and your body ends up eliminating more water than it absorbs and the person becomes dehydrated. The symptoms of dehydration are fatigue, back and neck pain, increase itch and headaches.

There is still some controversy over safe levels of intake e.g. low and moderate, however, it is still considered prudent to restrict intake whilst on medication. It is certainly recommended for psoriasis patients to reduce or totally restrict alcohol intake, regardless of type, whilst their psoriasis is in a flare up. And when in remission to only consume low to moderate levels of alcohol. All forms of binge drinking should be abstained from.

f you are using alcohol as a crutch to cope with your emotional distress, general stress with work etc. or depression then please seek medical assistance. Also read our blog on “Psoriasis and Water Intake”, “Stress, Anxiety, Depression and Psoriasis” and “Stressed about Psoriasis – Identify Your Stressors and Yours Stress Responses”. Identifying and understanding your stress triggers and finding other ways to cope with your stress and anxiety can help you cut back on your alcohol intake.

REFERENCES

  1. Poikolainen K. Et Al.; Alcohol Intake: A Risk Factor For Psoriasis In Young And Middle Aged Men? ; Bmj Volume 300 24 March 1990
  2. Iva Dediol, Marija Buljan, Danijel Buljan, Vedrana Bulat, Maja Vurnek Živkovi? & Mirna Šitum: Association Of Psoriasis And Alcoholism: Psychodermatological Issue Psychiatria Danubina, 2009; Vol. 21, No. 1, Pp 9–13
  3. Captain G E Vincenti and Dr S M Blunden; Psoriasis and Alcohol Abuse; JR Army Med Corps 1987; 133: 77-78
  4. Zimmerman GM. Alcohol and Psoriasis: A Double Burden.Arch Dermatol.1999;135(12):1541-1542. doi:10.1001/archderm.135.12.1541.
  5. Qureshi AA, Dominguez PL, Choi HK, et al. Alcohol intake and risk of incident psoriasis in US women: a prospective study. Arch Dermatol146(12):1364–9 (2010 Dec).
  6. Vena GA. et al.;The effects of alcohol on the metabolism and toxicology of anti-psoriasis drugs.; Expert Opin. Drug Metab Toxicol. 2012 Aug;8(8):959-72. doi: 10.1517/17425255.2012.691166. Epub 2012 May 17.