DEAR DR. ROACH: I have had an autoimmune disease called bullous pemphigoid for the past four years. I originally was treated with prednisone therapy for over a year, which was then tapered and changed to mycophenolate.
Currently my illness is under control with this treatment. How long is this illness likely to last, and is there anything I can do, such as diet, to alleviate the symptoms? — T.M.C.
ANSWER: Before the introduction of steroids like prednisone, bullous pemphigoid was a potentially fatal skin disease. Steroids are rapidly effective, but they have many side effects, so most experts use other medicines, such as mycophenolate.
Like many autoimmune diseases, bullous pemphigoid can get better and worse over time; it can go into remission (no symptoms), and it can relapse (flare up). A blood test (BP 180 antibody) sometimes predicts a relapse of the disease. Medications are often stopped in people who have complete remission; however, if the disease comes back, then treatment needs to be restarted.
Some people with bullous pemphigoid note worsening of their symptoms with a diet of onions, garlic or leeks. Diet also may help with side effects of the medication, especially the weight gain and elevated sugar levels that often accompany steroid treatment.
Much more information is available at www.pemphigus.org.
DEAR DR. ROACH: I am an active, healthy 86-year-old woman. My doctor ordered a vitamin D level, which I never had done before. I have been taking calcium citrate 600 mg daily, with vitamin D 650 IU.
My vitamin D level was over 60. I was told that my level was too high and that I should reduce my dose to 400 IU. I found that my multivitamin contained 1,000 IU vitamin D-3, so I have been taking a total of 1,650 IU in supplements. I informed my doctor of this, and switched to a multivitamin without D. She said I still should reduce to 400 IU.
My reading informed me that that is too low a dose to protect my bones for my age and gender. What is your opinion? (I am fair-skinned and live in Florida.) — N.H.
ANSWER: A vitamin D level greater than 60 is higher than optimal, and I agree that you should cut down on your supplements. People vary greatly in how much vitamin D they can make themselves. People with fair skin are capable of making more with less sun exposure than people with olive or darker complexions. For people who live in Florida, the sun is very efficient at making vitamin D, far more so than in those who live farther north. I agree with your doctor. A high level is more important than the number of IU you are taking daily. Many people will need 1,000-2,000 IU a day, but you don’t.
Not everyone needs to have his or her vitamin D level tested. In addition to darker-skinned people and those living in the North, those at a high risk for low vitamin D include people taking medications (especially Dilantin) that affect vitamin D; overweight individuals; those who are in a hospital or nursing home; and those who habitually wear sun-protective clothing. Vitamin D levels should be considered in people with malabsorption, especially inflammatory bowel disease and celiac disease, and anyone with osteoporosis.
The osteoporosis pamphlet furnishes details on how to prevent this nearly universal condition. Readers can obtain a copy by writing:
Dr. Roach
Book No. 1104
628 Virginia Dr.
Orlando, FL 32803
Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name address. Please allow four weeks for delivery.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.
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