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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
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
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
除此之外呢 ?
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
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 )
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
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
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
無麩質飲食
AGA, tTG
抗體下降
至正常
六個月無麩質飲食
7/8 乾癬病患皮膚症狀改善
這些抗體的出現
可用於識別對麩質敏感的個體
乾癬、乳糜瀉、掌蹠膿皰病
無麩質飲食
乾癬性關節炎
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
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
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
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
謝謝聆聽,歡迎指教

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20150822 無麩質飲食改善乾癬

Editor's Notes

  1. In coeliac disease (CD), the ingestion of gluten-containing cereals results in small bowel mucosal inflammation and villous atrophy with crypt hyperplasia resulting in malabsorption syndrome with symptoms such as diarrhoea and abdominal distension.
  2. IgA anti tissue transglutaminase (tTG) or IgA (or IgG) deamidated gliadin peptide (DGP) should be used to monitor the response to gluten-free diet
  3. [Take home message] Positive symptoms should prompt clinicians to test for 1. IgA Anti-gliadin Ab (AGA) 2. IgA Anti-endomysium Ab(EMA) 3. IgA Anti-tissue transglutaminase Ab (tTG) positive antibody results suggesting the potential benefit of a GFD.
  4. [Take home message] Positive symptoms should prompt clinicians to test for 1. IgA Anti-gliadin Ab (AGA) 2. IgA Anti-endomysium Ab(EMA) 3. IgA Anti-tissue transglutaminase Ab (tTG) positive antibody results suggesting the potential benefit of a GFD.
  5. 冬粉原料:純綠豆 米粉原料:米 不純的米粉:9成市售包裝米粉含米量過低,多以價格較低的玉米澱粉摻假