20150822 Silabus Dan SAP Kimia Dasar Politeknik Unggulan Kalimantan
20150822 無麩質飲食改善乾癬
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Transcript of 20150822 無麩質飲食改善乾癬
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無麩質飲食改善乾癬台北榮民總醫院過敏免疫風濕科
沈佑銓醫師
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乾癬與乾癬性關節炎•乾癬:不一定有乾癬性關節炎•乾癬性關節炎:不一定有乾癬
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乾癬病人避免以下狀況•感染•特定藥物•外傷 / 搔抓•皮膚乾燥•情緒起伏•睡眠不規則•服用免疫增強食品
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除此之外呢 ?
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無麩質飲食 - 改善乳糜瀉•對「麩質過敏」或者有「乳糜瀉」的患者宜在食物中去除麩質•乳糜瀉是一種小腸發炎、腸內膜受損的疾病,導致大部分食物的營養不能夠被身體吸收利用。•這種腸內膜的損害,是因為食用大麥、黑麥、燕麥時,對其中所含的麩質起了免疫反應的結果。
Reference: National Psoriasis Foundation/USA
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麩質是什麼 ?•又稱麩質蛋白、麥膠、麵筋、麵筋蛋白、谷膠蛋白•麩質蛋白是多個單一蛋白質的混合物,主要由醇溶穀蛋白以及穀蛋白兩種蛋白質組成。•存在於大麥、小麥、燕麥、黑麥 ( 裸麥 )
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無麩質食品 - 能否改善乾癬 ?
•乾癬患者 16-25%對麩質敏感•乾癬患者有較高機率併有乳糜瀉•乾癬患者有 HLA-Cw6 基因,易對麩質敏感•持續暴露在大量的麩質, IgA 濃度高; 當食物攝入麩質減少, IgA 會下降•無麩質飲食可以使皮膚和關節疼痛改善•無麩質飲食不見得每位患者都有效
Reference: National Psoriasis Foundation/USA
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乾癬患者 16% 有醇溶蛋白抗體 (anti-gliadin Ab, AGA)
33 AGA(+) 乾癬 PASI 82%
6 AGA(-) 乾癬 No response
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掌蹠膿皰病( Palmoplantar pustulosis,PPP)是一種慢性炎症疾病,有些病人併有乾癬
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無麩質飲食
AGA, tTG抗體下降至正常
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六個月無麩質飲食7/8 乾癬病患皮膚症狀改善
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這些抗體的出現可用於識別對麩質敏感的個體
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乾癬、乳糜瀉、掌蹠膿皰病
無麩質飲食
乾癬性關節炎
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無麩質食品需要注意什麼 ?•無麩質食品的維他命 B 、維他命 D 、鈣、鐵、鋅、鎂以及纖維等含量通常都比較低,長期使用可能造成這些營養素缺乏。•乳糜瀉患者採行了無麩質飲食法長達十年之後,半數研究對象出現維他命 B6與葉酸不足的問題
Reference: National Psoriasis Foundation/USA
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無麩質食品需要注意什麼 ?
•標記為「無小麥」,並不代表「無麩質」,如醬油、啤酒、麥芽醋、仿海鮮食品、穩定劑或乳化劑。•飲食是「無麩質」,並不代表「無熱量」,因常加入糖讓味道更好。•牛肉,雞肉,魚肉,羊肉,豬肉和乳製品等,本來就無麩質,但要留意添加劑。
Reference: National Psoriasis Foundation/USA
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無麩質食品需要注意什麼 ?
•嘗試無麩質飲食,需要幾個月等炎症消退。建議保持完全無麩質的至少三個月。•如果你不確定是否從無麩質飲食獲得好處,可將麩質食品加回,在接下來 3-4天,記下是否有增加搔癢,關節疼痛,頭痛等症狀。•如果無麩質飲食沒有任何好處,三個月後可以回復成原來飲食。
Reference: National Psoriasis Foundation/USA
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結論1.改善乳糜瀉2.對乾癬皮膚有效 ( 帶有 AGA, EMA, tTG 抗體者 )
3.對改善乾癬性關節炎證據較少至少三個月才能看見成效,有時要六個月若無效,可以再回復原本飲食並觀察
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謝謝聆聽,歡迎指教