Oral Nutritional Therapy - Psoriasis - Essay Example

Oral Nutritional Therapy - Psoriasis - Table of Contents I. Concept of Stress II. Effects of Stress in the Human Body ………………………………. 1 III. Homeostatic Imbalance of the Skin Causing Stress Related Skin Disorders ……………………………………… 1 IV. General Facts about the Skin ……………………………………….. 2 V. Clinical Facts about Psoriasis ...…………………………………..… 2 VI. Clinical Features of Psoriasis ………………………………………. 3 VII. Behavior of Psoriasis ………………………………………………. 3 VIII. Description of Various Kinds of Psoriasis ………………………… 3 IX. Duration of Psoriasis ………………………………………………. 4 X. Importance of the Essential Fatty Acid  Linoleic, Linolenic, and Arachidonic Acid ……………………………………. 4 XI. Special Functions of Linoleic Acid ………………………………… 5 XII. Special Functions of Alpha - & Gamma - Linolenic Acid and Arachidonic Acid ……………………………………………………. 5 XIII. Effects of Essential Fatty Acids (EFAs) on Psoriasis ………………. 6 XIV. Current Oral Nutritional Therapy  Psoriasis ……………………… 7 XV. Food Sources Rich in Linoleic Acid, Linolenic Acid, and Arachidonic Acid ……………………………………………………. 7 XVI. Alternative Oral Nutritional Supplements / Dietary Supplements ….. 7 XVII. A Balanced Ratio between the Intake of Omega-3 and Omega-6 …... 7 XVIII. Negative Effects of Over Consumption/Deficiency of the Three Essential Fatty Acids …………………………………………. 8 XIX. Positive Effect of Omega-3 and Omega-6 Oils in Psoriasis ………… 8 XX. Conclusion ………………………………………………………….. 8 References ………………………………………………………………… 10 - 11 Oral Nutritional Therapy: Psoriasis - 1 - Concept of Stress Stress refers to any event or set of circumstances which causes a disruptive physiological, mental, and emotional response to an individual. Among the common sources of stress are: internal stressors, external stressors, developmental stressors, and situational stressors. Understanding the concept of stress is very important because it can threaten the overall wellness of a human being. Effects of Stress in the Human Body Stress can cause a lot of changes in our body. Stress syndrome or General Adaptation Syndrome (GAS) occurs with the release of some adaptive hormones and subsequent changes in the structure and chemical composition of the body. Body organs that are commonly affected by stress are the gastrointestinal tract, the adrenal glands, and the lympatic structures like spleen, thymus, and lymph nodes. Sometimes, deep ulcers may appear in the stomach lining. 1 The GAS can cause a wide range of physiologic responses to the stressor. Stressor stimulates the sympathetic nervous system which in turn, stimulates the hypothalamus. It is the hypothalamus that releases corticotrophin releasing hormone (CRH) that stimulates the anterior pituitary gland to release adrenocorticotropin (ACTH). At time of stress, adrenal medulla secretes epinephrine and norepinephrine in response to sympathetic stimulation. Once the body responses to epinephrine, increased in myocardial contractility, bronchial dilation, increased blood clotting, increased in cellular metabolism, and increased in fat mobilization is likely to happen.2 Homeostatic Imbalance of the Skin Causing Stress Related Skin Disorders When our body cells and organs lost homeostasis, the effect can be revealed in the Oral Nutritional Therapy: Psoriasis - 2 - skin. There are around 1000 different ailments that can occur. Psoriasis is one of the most common skin disorders. In a lot of cases, these skin disorders are resulted from allergies of bacterial, viral, or fungal infections.3 General Facts about the Skin The skin determines whether a person is properly nourished or can be diagnosed as malnutrition. A person with good nutrition has a smooth, slightly moist, and is good in color skin. On the other hand, anyone who gets a poor nutrition has a rough, dry, scaly, pale, pigmented, irritated, and bruised skin. Clinical Facts about Psoriasis Psoriasis is a chronic, noninfectious, inflammatory disease of the skin wherein the production of the epidermal cells is about six (6) to nine (9) times faster than the normal rate. 4 For this reason, the normal event of the skin cell maturation and growth does not take place. Thus, the formation of normal layers that protects the skin is restricted. This type of skin disorder wherein there is an over production of keratin in the skin is hereditary. Stress and anxiety is known to trigger psoriasis. Other conditions that can worsen psoriasis include trauma, infections, seasonal weather, and hormonal changes. Usually, this type of skin disorder associated with asymmetric rheumatoid factor-negative arthritis of the several multiple joints. It is very much common to people between the ages 15 to 50 years old to experience psoriasis. The main areas that are affected within the human body are: the scalp, areas over the elbows and knees, the lower part of the back, and the genitalia of both male and female. Oral Nutritional Therapy: Psoriasis - 3 - Clinical Features of Psoriasis5 Psoriasis is a common chronic, recurrent, inflammatory disease of the skin characterized by rounded, circumscribed, erythematous, dry, scaling patches of various sizes, covered by grayish white or silvery white, imbricated, and lamellar scales. The lesions in ordinary cases have a predilection for the scalp, nails, extensor surface of the limbs, the elbows, the knees, and the sacral region. Usually, this kind of eruption is symmetrical which varies from a solitary macule to countless patches. This kind of eruption develops slowly and can be exanthematous, with a sudden onset of many guttate lesions. Sometimes it may consist of few inveterate patches. Symptoms like itchiness or burning sensation may also occur. Behavior of Psoriasis At the beginning, early lesions are covered with dry, silvery scales. These patches increase its size due to peripheral extension and by coalescence. It can become thicker due to the accumulation of the scales. Sometimes bleeding may appear upon the removal of the scales. This is true in cases whereby the scales become micaceous and are looser towards the periphery of the patches. These patches can reach up to a diameter of 5cm. Description of Various Kinds of Psoriasis The old patches can be thickened. When this happens, it becomes tough and usually covered with lamellar scales. This kind of psoriasis is called psoriasis ostracea. In psoriasis guttata, the lesions are the same as the size of water drops. Psoriasis follicularis is characterized by tiny scaly lesions that are normally located at the orifices of the pilosebaceous follicles. Oral Nutritional Therapy: Psoriasis - 4 - Psoriasis figurata, psoriasis annulata, and psoriasis gyrata occurs in a linear patterns; while the psoriasis discoidea has a central involution. Duration of Psoriasis The duration of Psoriasis is inconstant. Usually, it begins on the scalp or on the extensor surfaces of the elbows. Many times, it remains localized in the original region for an indefinite period of time. Sometimes, it could completely disappear, recur, or even spread on other parts of the human body. In fact, two of the main clinical features of psoriasis are its tendency to recur and to persist. It is very rare that a psoriatic patient will be free of this type of skin disease for years. Importance of the Essential Fatty Acid  Linoleic, Linolenic, and Arachidonic Acid In human nutritional science, the word ‘essential’ means that the human body is does not have the ability to produce them. Therefore, we must obtain these nutrients from our daily food intake. This essential fatty acid has special functions in our body. The absence of this essential fatty acid will lead to a deficiency disease state. Essential fatty acids are needed by human beings for normal brain function, the physical growth and development, the strengthening of the bone, regulation of the body metabolism, and the maintenance of the reproductive system. It also stimulates the hair growth and even the skin. Linoleic Acid (C17H31COOH), Linolenic Acid (C17H29COOH), and Arachidonic acid (20-COOH-AA) are all essential polyunsaturated fatty acid (PUFA). The only essential fatty acid that our body need is linoleic acid and alpha-linolenic acid.5 Both linolenic acid and arachidonic acid can be synthesized by our human body from linoleic Oral Nutritional Therapy: Psoriasis - 5 - acid.6 Therefore, it is important that we obtain linoleic acid from our daily diet. All these three (3) essential fatty acids are good fats. Special Functions of Linoleic Acid One of the important functions of the linoleic acid is the fact that it strengthens the structure of the skin membrane. It helps prevent an increase in the permeability of the both the skin and its membrane. The absence of the essential fatty acid would lead to a skin elasticity breakdown. An example of this condition is psoriasis, eczema, and other skin lesions. It also helps in lowering the serum cholesterol levels; helps prolong blood clotting; and plays an important role in the transportation and metabolism of cholesterol.7 Just like any other fatty acids, the combination of linoleic acid with cholesterol will form cholesterol esters. The cholesterol esters are the considered an important constituents of the adrenal glands. Special Functions of Alpha - & Gamma - Linolenic Acid and Arachidonic Acid Alpha-linolenic Acid (ALA) is an essential fatty acid (EFA) found in omega-3. 8 It is known to reduce inflammation and helps prevent some chronic cases of arthritis and heart diseases. ALA helps in the growth and development of our body. It is mostly stored in the brain. Thus, it helps us gain better cognitive and behavioral functions. Gamma-linolenic Acid (GLA) is an EFA found in the omega-6 family. According to some clinicians and researchers, GLA is useful as a nutritional therapy for diabetes, eye disease like Sjögrens syndrome, osteoporosis, eczema, etc.9 It is also good in treating problems related to inflammation and auto-immune diseases like psoriasis. To have a good nutrition, we have to balance the intake of omega-3 and omega-6 in our diet. Both must work together in order to promote and improve our health. Oral Nutritional Therapy: Psoriasis - 6 - Arachidonic acid is also called as dihomogamma-linolenic acid. Our body uses arachidonic acid in synthesizing our body’s regulatory molecules like prostaglandins – a hormone and thromboxanes – for blood clotting. Effects of Essential Fatty Acids (EFAs) on Psoriasis Omega-3 and omega-6 controls the chronic skin inflammation which is clinically present in psoriasis. The omega-3 stimulates the pro-inflammatory pathways in the human body and omega-6 stimulates the anti-inflammatory pathways. Therefore, the balance of the two is very important in minimizing the inflammation of the skin due to psoriasis. Psoriasis is an inflammatory disease. Therefore, the inflammatory response of psoriatic patient’s body does not respond to some microbial attacks and/or acute injury. Thus, damages to skin tissues and other organs of the body may occur. The intake of omega-3 helps regulate psoriatic patients’ body’s inflammatory response. Current Oral Nutritional Therapy  Psoriasis Since our body cannot produce these essential fatty acids. This is the main reason why we should highly depend so much on oral nutritional intake of these nutrients. Oral nutritional therapy can be achieved both by eating essential fatty acid rich food and/or by taking oral dietary supplements. This is the best and the most simplest therapy we could acquire in order to control, minimize and prevent skin disorders like psoriasis. Oral Nutritional Therapy: Psoriasis - 7 - Food Sources Rich in Linoleic Acid, Linolenic Acid, and Arachidonic Acid Among the foods that are rich in Linoleic acids are safflower, virgin coconut, and cottonseed oil (75%), corn oil (50 – 60%), nuts and poultry (20 – 30%), and avocado fruit (10%). Gamma-linolenic Acid (GLA) is basically a plant-based oil. Normally, linoleic acid can be obtained from cooking oils like linseed, evening primrose, borage, and black currant oils. Other food sources includes liver, soybean, pork fat, and some processed foods that are also fortified with GLA. On the other hand, peanut oil, egg yolk, and meat like chicken, pork, and beef are a good source of arachidonic acid. Alternative Oral Nutritional Supplements / Dietary Supplements There are a lot of supplementary nutrients readily available in the market. These supplements are usually sold in capsule form. Available GLA supplements are usually derived from black currant, borage seed, and evening primrose oil. A Balanced Ratio between the Intake of Omega-3 and Omega-6 It is very important to maintain a balanced consumption between the Omega-3 and Omega-6. According to the University of Maryland Medicine, the normal American diet must contain more of Omega-6 than Omega-3. Omega-6 consumption has to be at least 11 to 30 more than that of the other. The balanced ratio should be around 4:1 (Omega-6 : Omega-3). Oral Nutritional Therapy: Psoriasis - 8 - Negative Effects of Over Consumption/Deficiency of the Three Essential Fatty Acids The Omega-6, specifically the arachidonic acid can promote inflammation when taken in excess. Thus, too much intake of arachidonic acid can be harmful to the human body because it can lead to a lot of diseases. On the other hand, deficiency of these essential fatty acid can lead to growth gap, infertility, and inability of the body in terms of fighting infections. It also affects the overall human brain, central nervous systems, and membranes negatively. The abnormal omega-6 and omega-3 ratios have been linked to changes in the vascular membrane lipid composition. This is one factor that increases the incidence of atherosclerosis and inflammatory diseases.10 Positive Effect of Omega-3 and Omega-6 Oils in Psoriasis Omega-3 and omega-6 has the ability to increase the absorption of nutrients in our body. The essential fatty acids are responsible for the proper utilization and absorption of the vitamins and minerals needed for growth and development. The absorbed vitamins, minerals, and amino acids are essential and play an important role in decreasing the psoriasis condition. It helps restore the body’s normal condition. Conclusion Our human body is not capable of producing the essential fatty acids that are vital for the overall wellness of a person. This is the main reason why oral nutritional therapy is critical especially to those people who are suffering from skin disorders like psoriasis. We can obtain these essential fatty acids orally from the food we eat and/or in the form of Oral Dietary Supplements. Oral Nutritional Therapy: Psoriasis - 9 - These essential fatty acids are considered as good fats. However, there is a recommended dosage that we have to follow. In case of deficiency or in excessive in-take of these fatty acids would lead to a huge detriment on the health status of an individual. Oral nutritional therapy is a very sensitive topic. We have to be very careful as well as knowledgeable about the proper way of managing our nutritional daily diet. For example, any person who consumes an extra dosage of omega-6 nutritional supplement is most likely to suffer from skin disorders more than those who are aware of its negative effects. Also, one must be very particular about the expiration date of the product. This is enough reason to make a person with a skin disorder such as psoriasis worst. Therefore, it is always best to consult our physicians and/or nutritionists prior to the consuming of any of these oral nutritional dietary supplements. Physicians and/or nutritionists are definitely in a better position when it comes to recommending the right dosage of nutrients we need each day. Prevention is always better than cure. *** End *** Oral Nutritional Therapy: Psoriasis - 10 - References: 1 Selye, H. (1976). ‘The Stress of Life’ (revised Ed.) New York: McGraw-Hill. 2 Kozier, B. et.al. (2004) ‘Fundamentals of Nursing – Concepts, Process, and Practice’ 7th Ed. New Jersey: Pearson Education Inc. pp. 1015 – 1016 3 Marieb, E. (2003) ‘Essentials of Human Anatomy & Physiology’ 7th Ed. Benjamin Cummings; Pearson Education Inc. p. 107 4 Johnson, J.Y. (2004) ‘Handbook for Brunner & Suddarth’s Textbook of Medical Surgical Nursing: Psoriasis’ 10th Ed. Lippincott Williams & Wilkins. p. 642 5 Domonkos, A.N. (1982) ‘Andrew’s Diseases of the Skin – Clinical Dermatology’ 7th Ed. Press of W.B. Saunders Company. Pp. 223 - 224 6 Mahan, K.L. et.al. (2004) ‘Krause’s Food, Nutrition, & Diet Therapy: Chapter 3 – Macronutrients: Carbohydrates, Proteins, and Lipids (Ettinger, S.)’ 11th Ed. Elsevier (Singapore) Pte. Ltd. – Health Science Asia/Elsevier (USA) p. 37 7 Williams, S.R. (1989) ‘Nutrition and Diet Therapy: Lipids’ 6th Ed. Times Mirror/Mosby College Publishing. p. 69 8 DeBusk R. et.al. (April 2002) ‘Alpha-Linolenic Acid (ALA)’ University of Maryland Medical Center Retrieved: January 17, 2007 < http://www.umm.edu/ > path: supplements Oral Nutritional Therapy: Psoriasis - 11 - 9 DeBusk R. et.al. (April 2002) ‘Gamma-Linolenic Acid (GLA)’ University of Maryland Medical Center Retrieved: January 17, 2007 < http://www.umm.edu/ > path: supplements 10 Mahan, K.L. et.al. (2004) ‘Krause’s Food, Nutrition, & Diet Therapy: Chapter 3 – Macronutrients: Carbohydrates, Proteins, and Lipids – Essential Fatty Acid Deficiency’ (Ettinger, S.)’ 11th Ed. Elsevier (Singapore) Pte. Ltd. – Health Science Asia/Elsevier (USA) p. 56 Read More