Excessive fructose may set up metabolic trouble

Co-author Lars Berglund points out that fruit juices typically feature more concentrated forms of fructose and glucose, whereas fruits and vegetables contain fiber and other good stuff. "It's healthier to eat apples than to drink apple juice," he says.

A fructose-heavy diet may contribute to the development of metabolic syndrome, which can increase the risk of developing cardiovascular disease and diabetes.

The findings, published online in the journal Nutrition & Metabolism, come from a University of California, Davis, study that investigated the relative effects of fructose or glucose consumption on 32 older, overweight or obese men and women.

Straight from the Source DOI: 10.1186/1743-7075-9-68

The study participants consumed glucose- or fructose-sweetened beverages, which provided 25 percent of their energy requirements for 10 weeks.

Consumption of fructose, but not glucose, affected various parameters associated with metabolic syndrome, including increased circulating concentrations of uric acid, which is known to be higher in people with metabolic syndrome.

In addition, fructose consumption increased GGT activity, which is an indicator of liver dysfunction, and production of a type of protein known as RBP-4, associated with increased insulin resistance.

No previous studies have investigated the effects of glucose or fructose consumption on circulating levels of RBP-4.

The study design involved three phases, including a two-week inpatient baseline period, an eight-week outpatient intervention period, and a two-week inpatient intervention period.

During baseline, subjects resided in the UC Davis Clinical and Translational Science Center’s Clinical Research Center (CCRC) for two weeks before beginning the outpatient intervention, consuming either fructose- or glucose-sweetened beverages. They returned to the CCRC for the final two weeks of intervention.

Fasting and 24-hour blood collections were performed at baseline and following 10 weeks of intervention for measurement of plasma concentrations of uric acid, RBP-4, and liver enzyme activities.

The study’s first results, published in 2009, showed that visceral adipose volume (fat inside the abdominal cavity) was significantly increased only in subjects consuming fructose, along with increases in several circulating lipids and a decrease in insulin sensitivity, although both groups exhibited similar weight gain.

Diabetes: New Compound Prevents Retina Damage

A compound that prevents damage to the retina caused by diabetic retinopathy has been developed by scientists.

University of Michigan Kellogg Eye Center scientists have developed a compound that targets two mechanisms: inflammation and the weakening of the blood barrier that protects the retina that is the root cause of the disease.

Diabetic retinopathy is the most common diabetic eye disease. It is caused by changes in the blood vessels in the retina, and can cause blindness in adults.

In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In others, abnormal new blood vessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision.

Crystal structure of Vammin, a VEGF-F from a snake venom

Until now, scientists believed that retina damage was caused by the activity of vascular endothelial growth factor (VEGF), a protein that weakens the protective blood-retinal barrier.

Drugs, created to treat diabetic retinopathy, have been desigend to block the protein but now, researchers have found that inflammation could also contribute to the disease.

"In diabetic retinopathy and a host of other retinal diseases, increases in VEGF and inflammatory factors - some of the same factors that contribute to the response to an infection - cause blood vessels in the eye to leak which, in turn, results in a buildup of fluid in the neural tissue of the retina," said David A Antonetti, a Kellogg Eye Center researcher, in a statement. "This insidious form of modified inflammation can eventually lead to blindness."

Scientists created the new compound while studying kinase C (aPKC), a protein that was common to both mechanisms as an important target in regulating the disease process.

They claim that the new compound blocks the kinase C (aPKC) protein, which in turn blocks the VEGF protein and reduces inflammation.

"This is a great leap forward. We've identified an important target in regulating blood vessel leakage in the eye and we have a therapy that works in animal models. Our research is in the early stages of development. We still have a long way to go to demonstrate effectiveness of this compound in humans to create a new therapy but the results are very promising," Antonetti said.

Diabetes Reversed in Mice Using stem Cells

Canadian scientists were able to reverse diabetes in mice with a human stem cell transplant, igniting hopes for a cure for the widespread disease, caused by the failure of the pancreas to produce enough insulin to stabilize blood sugar levels in humans.

A paper outlining the work, led by Timothy Kieffer of the University of British Columbia and conducted in partnership with New Jersey-based company BetaLogics, appeared in the journal Diabetes on Tuesday.

Diabetic mice were weaned off of insulin after receiving the pancreatic stem cell transplant, which restarted the cycle in which insulin production rises or falls based on blood sugar levels.  Three to four months later, the mice could maintain healthy blood sugar levels even after being fed a lot of sugar.

"We are very excited by these findings, but additional research is needed before this approach can be tested clinically in humans," Kieffer said in a statement on Tuesday.

The researchers cautioned that their study used mice that had a suppressed immune system, the better to prevent rejection of the transplanted cells.

"We now need to identify a suitable way of protecting the cells from immune attack so that the transplant can ultimately be performed in the absence of any immunosuppression," Kieffer said.

In 2009, a different team of researchers led by scientists from the University of Sao Paulo in Brazil and Northwestern University reported in the Journal of the American Medical Association that they were able to successfully reverse type 1 diabetes by injecting 8 patients with some of their own stem cells.

Some studies have shown that this kind of stem cell transplantation is only a temporary fix - after anywhere between six months to three years, the insulin-producing cells are again attacked by the patient's immune system.

SOURCE: Rezania et al. "Maturation of Human Embryonic Stem Cell-Derived Pancreatic Progenitors into Functional Islets Capable of Treating Pre-existing Diabetes in Mice." Diabetes 27 June 2012.

Diabetes, Weight Loss Surgery Works Better Than Medicine

Two studies have found that weight-loss operations worked much better than the standard therapies for Type 2 diabetes in obese and overweight people whose blood sugar was out of control. 

Those who had surgery, which stapled the stomach and rerouted the small intestine, were much more likely to have a complete remission of diabetes, or to need less medicine, than people who were given the typical regimen of drugs, diet and exercise.

The surgery also helped many to lower their blood pressure and cholesterol.

The new studies, published on Monday by The New England Journal of Medicine, are the first to rigorously compare medical treatment with these particular stomach and intestinal operations as ways to control diabetes. 

Doctors had been noticing for years that weight-loss operations, also called bariatric surgery, could sometimes get rid of Type 2 diabetes. But they had no hard data.

Experts say better treatments are desperately needed for the disease.

“Type 2 diabetes is one of the fastest growing epidemics in human history,” according to an editorial published with the two studies.

The question is whether major surgery, with its risks and complications, should be more widely used. 

Some surgeons and obesity experts are pushing to establish a role for the surgeries in treating diabetes, not just obesity, while other experts say more research is needed.

The president for medicine and science for the American Diabetes Association, Dr. Vivian Fonseca, said the two studies were “not game changers” because they were relatively small.

The disease, which causes high blood sugar, is linked to obesity and often becomes harder to manage as it progresses. It can bring devastating complications like heart disease, strokes, blindness, amputations and kidney failure.

In the United States, the number of diabetes cases has tripled in the past 30 years to more than 20 million, according to the Centers for Disease Control and Prevention. Most of the cases are Type 2. Type 1, far less common, is not linked to obesity.

Researchers said the operations used in the studies help control diabetes not just because they make people lose weight — a known treatment for the disease — but because the changes in anatomy alter the levels of gut hormones that affect the metabolism of sugars and fats.

Genetic study links body clock receptor to diabetes

A study published in Nature Genetics today has found new evidence for a link between the body clock hormone melatonin and type 2 diabetes.

The study found that people who carry rare genetic mutations in the receptor for melatonin have a much higher risk of type 2 diabetes.

The findings should help scientists to more accurately assess personal diabetes risk and could lead to the development of personalised treatments.

Previous research has found that people who work night shifts have a higher risk of type 2 diabetes and heart disease. Studies have also found that if volunteers have their sleep disrupted repeatedly for three days, they temporarily develop symptoms of diabetes.

The body's sleep-wake cycle is controlled by the hormone melatonin, which has effects including drowsiness and lowering body temperature.

In 2008, a genetic study led by Imperial College London discovered that people with common variations in the gene for MT2, a receptor for melatonin, have a slightly higher risk of type 2 diabetes.

The new study reveals that carrying any of four rare mutations in the MT2 gene increases a person's risk of developing type 2 diabetes six times.

The release of insulin, which regulates blood sugar levels, is known to be regulated by melatonin. The researchers suggest that mutations in the MT2 gene may disrupt the link between the body clock and insulin release, leading to abnormal control of blood sugar.


Professor Philippe Froguel, from the School of Public Health at Imperial College London, who led the study, said: "Blood sugar control is one of the many processes regulated by the body's biological clock.

This study adds to our understanding of how the gene that carries the blueprint for a key component in the clock can influence people's risk of diabetes.

"We found very rare variants of the MT2 gene that have a much larger effect than more common variants discovered before. Although each mutation is rare, they are common in the sense that everyone has a lot of very rare mutations in their DNA. Cataloguing these mutations will enable us to much more accurately assess a person's risk of disease based on their genetics."

In the study, the Imperial team and their collaborators at several institutions in the UK and France examined the MT2 gene in 7,632 people to look for more unusual variants that have a bigger effect on disease risk.

They found 40 variants associated with type 2 diabetes, four of which were very rare and rendered the receptor completely incapable of responding to melatonin. The scientists then confirmed the link with these four variants in an additional sample of 11,854 people.

Professor Froguel and his team analysed each mutation by testing what effect they have on the MT2 receptor in human cells in the lab. The mutations that completely prevented the receptor from working proved to have a very big effect on diabetes risk, suggesting that there is a direct link between MT2 and the disease.

More information: A. Bonnefond et al. 'Rare MTNR1B variants impairing melatonin receptor 1B function contribute to type 2 diabetes' Nature Genetics, published online 29 January 2012.

Rising levels of Diabetes in developing countries

As income levels rise around the world, health experts expect a more troubling figure to increase as well: the number of diabetics in developing countries.

In China and India, two of the world’s most populous nations with fast-paced economies, the prevalence of diabetes is expected to double by 2025.

Between 15 and 20 percent of their adult population will develop the disease as household budgets increase, diets change to include more calories and new health problems emerge.

Clearly, China, India and other developing countries are not fully prepared for, nor are they willing to deal with, the rising trend of diabetes

Not surprisingly the growing number of diabetics are currently not getting the care they need to prevent serious complications, Stanford researchers say.

Even looking at it from the unrealistic US medical insurance perspective, many diabetics cannot afford, nor have access to, essential medications that could help them manage their conditions.

In many cases, people are spending a great deal of their household incomes to pay for treatment, said Jeremy Goldhaber-Fiebert, an assistant professor of medicine who led the research team.

“The US model of Public and Private health insurance programs are not openly in place or are simply unaffordable for the majority of citizens in India and China, so this is not an option in providing sufficient protection from diabetics in most developing countries,” said Goldhaber-Fiebert, a faculty member at Stanford Health Policy at the university’s Freeman Spogli Institute for International Studies.

“The very few people who can afford some form of insurance aren’t doing any better than those who don’t have it because it is not controlled or legislated properly."

"Health insurance and health systems in developing countries need to be 're-oriented' to better address long term conditions and chronic diseases like diabetes.”

Findings from the study are online and will be published in the Jan. 24 edition of Diabetes Care, the journal of the American Diabetes Association. 

Continuous Glucose Monitoring for Diabetics Uses Microneedles & Smartphones

They all knew somebody with diabetes: grandparents, friends, even a girlfriend.

Such close contact with the disease drove the four engineering students to form a startup around a painless, wireless monitor that could change the lives of the 26 million Americans with the disease.

Their invention might also revolutionise a self-diagnosis industry worth billions of dollars.

The big innovation in GlucoReader comes from using tiny microneedles to draw blood, as opposed to their traditional use in delivering drugs without the painful injections. The method is painless compared to pricking a finger to draw blood, and can be worn as a patch on a person's shoulder.

By contrast, more expensive continuous glucose monitors on the market merely draw fluid from the body and still require finger-stick tests as backup. MobiLIFE's new device holds the promise of eliminating the pain and boosting the comfort of users, as well as giving more accurate readings.

Type 2 diabetics, whose bodies don't produce enough insulin, could use the GlucoReader to spot-check their blood sugar levels after eating. But Type I diabetics, who can't create the insulin necessary to break down sugars such as glucose, need constant monitoring to get regular doses of insulin.

"Type 1 diabetics require these readings throughout the day at 5- to 10-minute intervals to sync up with an insulin-delivery system," Chan told InnovationNewsDaily. "They're not receiving the most efficient and best system possible."

GlucoReader's patch also holds a Bluetooth device that transmits the blood test data wirelessly to a mobile device such as the iPhone or Android smartphone. That could replace the wired-up monitor system that some diabetic patients must wear at all times.

The price is right

Accurate readings also matter in terms of expenses for Type 1 diabetics who require constant monitoring. Insurance companies don't cover continuous glucose-monitoring devices because they are not considered reliable replacements for the usual finger-stick tests. That makes such devices a pricey proposition with costs ranging from $1,000 to $3,000.

The MobiLIFE co-founders estimate that GlucoReader will cost about $500 or $600. The device would also be covered by insurance, as long as the startup can show that its results are accurate enough to replace the finger-stick method.

MobiLIFE continues to tackle engineering challenges such as reducing the power consumption of the Bluetooth transmitter in the patch. It is also refining the ideal size and shape of the microneedles as it moves from blood tests to animal tests in the next six months.

The startup has also begun looking for angel investors as well as applying for grant funding from various government, academic and nonprofit organizations. If it all comes together, MobiLIFE stands to do well by everyone.

"As a small company, we're able to use recent technology to scale down and reduce the cost and footprint of our device," Chan explained. "The cost savings go back to the consumer."

Gut Bacteria helps fight Influenza and Lung Disease

Bacteria have their place. They are not always bad and sometimes they are beneficial.

They aid in digestion, help keep our intestines harmoniously balanced, and are even important in diabetes, obesity, and inflammatory bowel disease.

But what about beyond our gut? Scientists found that bacteria can avert the flu by keeping the immune system on alert for seasonal viral intruders.

Mice on antibiotics can’t fight the flu as well as mice that haven’t taken the drugs, researchers say.

Antibiotics quash the immune system’s infection-fighting power by killing friendly bacteria living in the intestines.

For a month, the researchers treated mice with antibiotics commonly given to people with bacterial infections and then they gave them the flu. The treated mice were more susceptible.

Turns out, the naturally-occurring bacteria taken out by antibiotics actually help produce flu-fighters – like immune cells and antibodies that fend off the viral infection.

The gut is where the bulk of the body’s roughly 100 trillion ‘commensal’ – harmless or beneficial – bacteria live [Nature]. And since lungs are normally sterile, it was a bit of a surprise that killing bacteria as far away as the colon would have any effect on how well the lungs could fight viruses [Science News].

“It seems that the commensal bacteria in the gut are providing a crucial signal throughout the body that prepares the body for fighting infection,” says lead author Akiko Iwasaki of Yale. “And it’s probably not only restricted to lungs.”

The findings suggest that long-term use of antibiotics could hamper our ability to fight influenza, Iwasaki says, perhaps even impair the effect of a vaccine.

Additionally, it also implies that our diet affects our ability to fight viruses by influencing the composition of our beneficial bacteria. For example, probiotic treatments, like yogurt, may help stimulate our immune systems during flu season.

The study was published in the Proceedings of the National Academy of Sciences this week.

Natural drug Abscisic Acid's infection fighting mechanism revealed

The scientists had reported some of the key molecular events in the immune system of mice that contribute to inflammation-related disease, including the involvement of a specific molecule found on the surface of immune cells involved in the body’s fight against infection (http://www.ncbi.nlm.nih.gov/pubmed/21068720). 

They have now gone one step further and revealed the mechanism by which the natural drug abscisic acid interacts with this protein, known as peroxisome proliferator-activated receptor-gamma, to block inflammation and the subsequent onset of disease.

“In previous work, our research group demonstrated that abscisic acid has beneficial effects on several conditions and diseases including obesity-related inflammation, diabetes, atherosclerosis, and inflammatory bowel disease,” said Josep Bassaganya-Riera, associate professor of immunology at the Virginia Bioinformatics Institute, leader of the Nutritional Immunology and Molecular Medicine Group in the institute’s CyberInfrastructure Division, and principal investigator of the study.

“One idea for how abscisic acid reduces inflammation in these instances is that it binds to a special region of peroxisome proliferator-activated receptor-gamma, a binding site known as the ligand-binding domain where the drug would be expected to latch on to and exert its effect. 

Our results show that this is not the case and, for the first time, we have demonstrated that abscisic acid works independently of this ligand-binding domain of the receptor.”

More information on this article here Science Blog

Risk of heart attack in patients

Risk of heart attack in patients

Rheumatoid Arthritis (RA) patients face a two-fold increased risk of suffering a Myocardial Infarction (MI, heart attack) versus the general population, which is comparable to the increased risk of MI seen in diabetes patients, according to results of a new study presented today at EULAR 2010, the Annual Congress of the European League Against Rheumatism in Rome, Italy.

In this Danish, nationwide, 10 year study, RA and diabetes patients were directly compared to assess their individual risk of having an MI over time. In those patients that developed RA, the Incidence Rate Ratio (IRR) of experiencing a MI was increased to 1.65 (95% Confidence Interval (CI) 1.46-1.86), comparable to the increased risk of MI seen in patients developing diabetes mellitus (IRR 1.73 95% CI (1.68-1.79)). Data was further analysed to examine increased risk in certain age groups and researchers found that the risk of MI was increased six-fold in women with RA younger than 50 years (IRR 6.01 95% CI (3.62-9.99)) comparable to diabetic women in the same age range (IRR 6.13 95% CI (4.99-7.54)). Overall, the risk of MI in patients with RA and diabetes was similar for male patients at IRR 1.66 (1.39-1.98) and 1.59 (1.53-1.66) respectively.

“While we already know that RA is an independent risk factor for cardiovascular disease, our data highlight that the increased risk of a heart attack faced by RA patients is of a similar magnitude as that faced by diabetes patients, who in contrast to RA patients are routinely considered for intensive cardiovascular risk management,” said Dr. Jesper Lindhardsen, Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark, and lead author of the study. “This study underlines the importance of implementing EULAR recommendations advocating early detection and management of cardiovascular risk factors, as well as providing sufficient RA treatment in order to reduce the significant burden associated with cardiovascular disease co-morbidity and mortality.”

The study, which was supported by the Danish Rheumatism Association, analysed data from the entire Danish population (n=4,614,840, minimum 10 years old) and monitored for incidence of diabetes and RA between 1997 and 2006 (or the date of patients first MI, whichever came first). A total of 10,547 people developed RA and 132,868 developed diabetes. IRR was calculated and analysed by multiple Poisson regression, a statistical technique utilised for modeling and analyzing several variables in a patient population.

Email: eularpressoffice@uk.cohnwolfe.com

About EULAR
The European League Against Rheumatism (EULAR) is the organisation which represents the patient, health professional and scientific societies of rheumatology of all the European nations.

In line with The European Union of Medical Specialists (UEMS), EULAR defines rheumatology as including rheumatic diseases of the connective tissue, locomotor and musculoskeletal systems.

The aims of EULAR are to stimulate, promote, and support the research, prevention, treatment and rehabilitation of rheumatic diseases. To this end, EULAR fosters excellence in education and research in the field of rheumatology. It promotes the translation of research advances into daily care and fights for the recognition of the needs of people with rheumatic diseases.

EULAR 2010 is set to be the biggest rheumatology event in Europe with over 15,000 scientists, physicians, allied health professionals, and related audiences in attendance from over 100 countries. Over the course of the congress, almost 300 oral and more than 1600 poster abstract presentations will be featured, with 300 invited speaker lectures taking place in more than 140 sessions.

To find out more about the activities of EULAR, visit: http://www.eular.org/

A new strategy to restore normal blood sugar levels in diabetes

Researchers at Children's Hospital Boston have identified a new strategy for treating type 2 diabetes, identifying a cellular pathway that fails when people become obese.

By re-activating this pathway artificially, they were able to normalize blood glucose levels in severely obese and diabetic mice. Their findings will be published online by Nature Medicine on March 28.

Epidemiologists have long known that obesity contributes to type 2 diabetes. In previous work, researcher Umut Ozcan, MD, in Division of Endocrinology at Children's, showed that the brain, liver and fat cells of obese mice have increased stress in the endoplasmic reticulum (ER), a structure in the cell where proteins are assembled, folded into their proper shapes, and dispatched to do jobs for the cell. In the presence of obesity, the ER is overwhelmed and its operations break down.

This so-called "ER stress" activates a cascade of events that suppress the body's response to insulin, and is a key link between obesity and type 2 diabetes.

To read the full article click here

One sleepless night can induce insulin resistance in healthy people

1 sleepless night can induce insulin resistance in healthy people ScienceBlog.com

According to a new study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM), just one night of short sleep duration can induce insulin resistance, a component of type 2 diabetes.

"Sleep duration has shortened considerably in western societies in the past decade and simultaneously, there has been an increase in the prevalence of insulin resistance and type 2 diabetes," said Esther Donga, MD of the Leiden University Medical Center in The Netherlands and lead author of the study.

"The co-occurring rises in shortened sleep and diabetes prevalence may not be a coincidence. Our findings show a short night of sleep has more profound effects on metabolic regulation than previously appreciated."

Previous studies have found that reductions in sleep duration over multiple nights result in impaired glucose tolerance, but this is the first study to examine the effects of only a single night of partial sleep restriction on insulin sensitivity.

In this study, researchers examined nine healthy subjects, once after a night of normal sleep duration (approximately eight hours), and once after a night of four hours of sleep.

Insulin sensitivity of each study participant was measured using the hyperinsulinemic euglycemic clamp method. This method uses catheters to infuse glucose and insulin into the bloodstream and then determines insulin sensitivity by measuring the amount of glucose necessary to compensate for an increased insulin level without causing hypoglycemia.

"Our data indicate that insulin sensitivity is not fixed in healthy subjects, but depends on the duration of sleep in the preceding night," said Donga. "In fact it is tempting to speculate that the negative effects of multiple nights of shortened sleep on glucose tolerance can be reproduced, at least in part, by just one sleepless night."

Donga adds that further studies are needed to evaluate whether interventions aimed at improving sleep duration may be beneficial in stabilising glucose levels in patients with diabetes.

The article, "A single night of partial sleep deprivation induces insulin resistance in multiple metabolic pathways in healthy subjects," will appear in the June 2010 issue of JCEM.

To learn more about the Society and the field of endocrinology, visit their web site at www.endo-society.org.

Psoriasis: debilitating socially and emotionally

“Psoriasis is a predisposition for your immune system to react with your skin,” said Dr. Ellen Marmur, chief of the Division of Dermatologic and Cosmetic Surgery at Mount Sinai Hospital in New York City.

“Something that would normally… trigger a slight reaction in most of us, will trigger a domino effect in somebody with psoriasis.”

Beneath the surface, a psoriasis patient’s immune system overreacts and begins to attack itself. This abnormal activity is more characteristic of an autoimmune disease such as multiple sclerosis or rheumatoid arthritis.

Healthy skin regenertaes itself every 28 days but with psoriasis and as a result of inflammation, skin cells regenerate every two to four days, causing an excessive build up of cells.

When this happens, patches of the skin develop plaque, which is thick, red and scaly. The dead cells surface on top of irritated areas as loose, dry skin. They have a silver-white color and can flake off or crack. Depending on the type and severity, psoriasis can be painful and itchy.

In addition to the symptoms experienced, psoriasis patients who scratch their skin are likely to encounter or create further damage.

“If you scratch your skin, or if you have a piece of clothing that rubs against your skin in the area that is irritated, you can develop psoriasis. This is called the Koebner phenomenon,” said Dr. Mark Lebwohl, chairman of the Department of Dermatology at Mount Sinai School of Medicine and Mount Sinai Hospital.

Causes
Outbreaks are usually triggered by environmental factors like skin injuries; cold weather, infections, such as strep throat; bad reactions to medications; and even stress.

Psoriasis isn’t contagious. It can affect anyone and can plague anyone from babies to the elderly, Lebwohl said.

While some cases are so mild the patient doesn’t realise they have psoriasis, severe cases can be very debilitating and cover nearly the entire surface of the body.

The elbows, knees and scalp are the most common areas to be affected, however, psoriasis can present anywhere on the body, Marmur said.

Mild psoriasis is defined as 3 percent body coverage and severe psoriasis as 10 percent or more. Approximately 25 percent of those with psoriasis have a moderate or severe case.

There are a number of Types of Psoriasis
Where it turns up and how severe it is, has a lot to do with which of the five types of psoriasis you have.

1. Psoriasis vulgaris, also known as plaque psoriasis, is the most common, affecting more than 80 percent of all psoriasis patients. It can be a really well circumscribed pink, red plaque with a silvery or gray scale.

2. Guttate psoriasis is also red and scaly but smaller and typically covers larger body parts. It affects approximately 10 percent of psoriasis patients and can be triggered by strep throat.

3. Inverse psoriasis is red but doesn’t have the silvery-white scales. It presents as moist and red and covers smooth, creased areas of the skin like the armpits, the groin and underneath the breasts. Obese patients are most prone and tend to have more severe symptoms

A large portion of psoriasis patients are obese or become obese, said Lebwohl, who includes a heart-healthy diet as one course of action to improve your condition.

4. Pustular psoriasis looks like little spots of acne all over the body, Marmur said.

5. Erythrodermic psoriasis is the most severe form of the disease when plaque covers most of the body surface

Pustular and erythrodermic psoriasis are the rarest and the most dangerous. While they can occur independently, patients who develop them generally have plaque psoriasis. They are potentially fatal because they compromise the body’s ability to ward off infections and control body temperature.

“The typical story will be a patient with plaque psoriasis is given systemic steroids, cortisone,” Lebwohl said. “That clears psoriasis, but as you take them off of the steroids, you can develop a horrific flare where your body gets covered head to toe with red skin, or covered with puss pimples… Many of these patients will grow bacteria in their blood and can actually die from sepsis.”

Problems Associated With Psoriasis
Patients can become anemic from dangerously low amounts of protein in the blood, or suffer from other factors as a result of these debilitating forms of the disease.

When treating a psoriasis patient, doctors will ask a series of questions called the SF-36 to measure how it has impacted there lives.

In addition to its debilitating physical and psychological effects, psoriasis can force patients to miss work in order to manage their disease. Some of Lebwohl’s psoriasis patients have lost, or quit their jobs because of the amount of time they had to take off, he said. Others quit because of the embarrassment of not being able to perform.

“The National Psoriasis Foundation has looked at the incomes of patients and, basically, you can correlate income negatively with the various severities of the disease. The more severe, you’re going to earn less money,” said Lebwohl, who is also the chairman of the Medical Board of the National Psoriasis Foundation.

The disease is also linked to cardiovascular disease, diabetes and depression.

“Not only can it be debilitating socially and emotionally, but people with psoriasis also have a risk of other internal diseases,” Marmur said. “It’s like running your car at maximum, you’re just going to burn out other parts of the engine and infrastructure, other things are likely to premature wear or to be damaged.”

Dealing with the effects
Make sure you have been correctly diagnosed. Consult regularly with your doctor to ensure that you are receiving the best medical treatment. In addition to this, seek out local self help groups where you can share experiences and get practical advice. Keep up to date on the latest research but don't be the first one to try it.

Check what you are eating and try to establish living and healthy eating patterns, reducing your intake of artificial chemicals, sugar and caffeine. Also actively pursue activities which you enjoy and which relax you, give you a sense of well being. Learn to relax yourself through yoga, meditation or simply reading a book in a warm quiet room.

It is often difficult to mix well in groups and crowds because of the skin irritation but mainly because of the 'stigma' that makes you feel less worthy. Psoriasis and many other skin complaints do severely damage the self esteem and this leads to self isolation and exclusion from society. Seek out a good friend and ask for their help and support in keeping you socially active, simply by accompanying you to venues. To tell you the truth, we all do it, why not you?