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It’s no secret that our bodies require a host of different vitamins and minerals to function at their best.
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A team at the University of Virginia has developed a monoclonal antibody to stop sepsis, the leading cause of death in U.S. hospitals.
There is good news from Virginia when it comes to the deadly infection sepsis.
“This is truly a groundbreaking discovery,” said Jianjie Ma, a professor in the department of surgery at the University of Virginia. “Sepsis is a very challenging disease to treat.”
Ma is part of the team at U.Va., along with the University of Michigan, that has developed a monoclonal antibody to stop sepsis. The deadly infection impacts up to 50 million people worldwide every year, killing about 11 million people, according to researchers. It’s the leading cause of death in U.S. hospitals.
“It’s a really urgent matter in the hospital, because when patients are admitted to the hospital, they have to be treated right away,” he said. “Any delay, one hour delay will cost 5% to 10% chance of people dying.”
U.Va. has received $800,000 from the research company Virginia Catalyst to launch a clinical trial of the antibody at U.Va. Health and Virginia Commonwealth University.
“Our technology will, can stop the dying process by targeting the very innate immune defense of our body,” Ma said.
He said the antibody has the potential to treat a range of inflammatory conditions, including autoimmune disorders.
“We are ready, and we have a lot of goals ahead of us,” Ma said. “It’s a really urgent matter in the hospital.”
He said applications could include deadly acute respiratory distress syndrome, which came to public attention during the COVID-19 pandemic, as well as ischemia-reperfusion injury, which is tissue damage caused when blood flow is cut off and restored.
“We have now made the antibody drug product available to start the clinical trial as soon as we can,” he said.
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Valerie Bonk
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What if the very hormone designed to help you survive is actually the reason you’re struggling to thrive?
My mother relentlessly saved and sacrificed so that she could enjoy her life in retirement. But two years into retirement, she was diagnosed with early onset Alzheimer’s.
Here’s what I’ve learned since becoming a Functional Diagnostic Nutrition Practitioner: she didn’t just “get” Alzheimer’s two years after retirement. It was building and building for years before that. She was making it worse with lifestyle choices: the over-exercising that women in their 40s and 50s often do, eating trans fats during the low-fat craze of the 80s and 90s.
Had I known what I know now, her outcome might have been different.
This is why I’m passionate about functional health. This is why thousands of practitioners are learning to identify and address the root causes of dysfunction before they become disease. If we can reach people in that gray space (when things are out of balance but before they become diagnosable conditions), we can change their trajectory. We can save lives.
As functional health practitioners, we see it every day: clients who’ve tried everything, followed every protocol, cleaned up their diet, and taken all the right supplements, yet they’re still stuck in that frustrating place of “I’m okay, but I’m not great.”
The missing piece? Understanding cortisol and its profound impact on every system in the body.
If you’ve ever wondered why some clients get amazing results while others plateau, or why you yourself might be experiencing symptoms that doctors dismiss as “normal aging,” this deep dive into cortisol will change everything.
Before we dive into cortisol, let’s get clear on what we’re actually working toward. At FDN, we don’t believe in “fine” or “okay.” We believe in abundant vitality.
Picture this as a spectrum:
The Right Side (The Medical Model): Symptoms → Sickness → Disease → Death
The Middle (Neutral Health): No symptoms, but no energy either. This is the “I’m fine, I guess” zone where most people live.
The Left Side (True Wellness): High energy, optimal function, metabolic fire, abundant vitality, joy for life.
Here’s the thing: neutral health equals a neutral life. When you’re operating from “I’m okay, I don’t have any complaints,” you’re not building empires, writing books, raising joyful kids, or showing up as your best self in relationships.
Good health, abundant vitality, is your birthright. It’s not just for the lucky few.
Your body is a self-healing machine. You know this because when you get a cut, it heals. When you break a bone, it mends. When you catch a cold, you recover.
But this healing ability isn’t infinite. If it were, we’d never age or die.
So what’s the difference between what your body can heal and what it can’t?
It’s a savings versus spending problem.
Think of your body as having a bank account called “Vital Reserve.” This is your innate intelligence: your body’s natural ability to function at 100% and fix imbalances before they become problems.
Where do you spend this precious currency? On your environment.
This has always been the case. Our paleolithic ancestors spent their Vital Reserve on not knowing if food would be available, dealing with harsh weather, avoiding predators, and navigating tribal conflicts.
Today? We spend it on mental-emotional stress, environmental toxins, and poor lifestyle habits that are constantly draining our account.
The main spender of Vital Reserve is stress.
When most people think of stress, they picture this: work deadlines, traffic, relationship conflicts, financial pressure. And yes, these mental-emotional stressors are huge.
But there are two other categories most people completely miss:
Physical Stressors:
Environmental Stressors:
Plus, there’s the existential stress of modern life: What’s my purpose? How do I make my life meaningful when I’ll likely be forgotten in 100 years?
All of these are constantly withdrawing from your Vital Reserve account.
Cortisol is your primary stress hormone, and it’s actually designed to help you survive. When your environment throws stressors at you, cortisol says, “We need to put internal spending on hold and take all available resources to deal with this external threat.”
Cortisol breaks the body down for quick energy. We call this “catabolic.”
Why would your body have a mechanism for breaking itself down? Because sometimes you need energy RIGHT NOW. When your boss says, “This project is actually due in 30 minutes,” you can’t drive to the store, buy food, cook it, eat it, digest it, and then produce energy. You need quick fuel immediately.
So cortisol reaches for easy-to-break-down tissues like cartilage, tendons, connective tissue, and muscle, converting them to blood sugar.
Here’s the kicker: Cortisol is also a natural painkiller and anti-inflammatory. It masks the damage it’s doing, which is why it makes you feel amazing in the moment: clear thinking, quick reactions, pain-free movement.
Think of cortisol as your body’s credit card. You’re borrowing energy now and promising to pay it back later through rest, recovery, and healing.
Throughout history, humans dealt with stress that was intense but occasional and short-lived. A wild animal attack, a natural disaster, a tribal conflict: these were serious but temporary.
Take a moment to think about this: Does this describe the stress in your life?
For most of us, stress is intense, constant, and never-ending. We wake up stressed, work stressed, drive home stressed, and lie in bed stressed about tomorrow’s stress.
This creates what we call “catabolic debt”: you’re constantly running up charges on your cortisol credit card without ever paying it back.
Chronic stress is not within our biological design.
Consider this: Anthropological studies show paleolithic humans worked only 15-20 hours per week. How many of you work only 15-20 hours per week? (And remember, “work” includes housework, childcare, and all the other responsibilities that don’t stop when you leave the office.)
They lived in close communities with cooperative resource sharing and had each other’s backs. Think about your own life: Do you know your neighbors? If you do, would they really have your back if things got serious?
Most of us are duplicating resources instead of sharing them. We’re all figuring out our own childcare, making our own meals, maintaining our own everything. There’s no interdependence, no shared load.
The cost of modern life is enormous:
This is where it gets really interesting. Understanding this curve will change how you see your health (and your clients’ health) forever.
We all start in the green zone: Homeostasis. When you experience occasional stressors, cortisol and adrenaline spike, you handle the situation, then return to baseline to rest and repair.
But when stress becomes chronic, you move into the orange zone: Acute Stress. You’re constantly producing cortisol and adrenaline, never returning to homeostasis.
Here’s the thing: on your way up this curve, you feel AMAZING. Remember when you could pull all-nighters and still ace exams? When you could eat junk food without consequences? When you had laser focus for 12-16 hours straight?
That’s the acute phase. You’re running on cortisol, and it feels like superpowers.
Then you hit Peak Production. Your body says, “We’ve put way too much on the cortisol credit card. We have to cut back.”
Now you fall into the Compensatory Phase. Your cortisol numbers might look normal to a doctor, but the distribution is all wrong. Maybe you have too much in the morning and crash by afternoon, or you spike at night and can’t sleep.
Plus, you have a relativity problem. You’re used to feeling like Superman from the acute phase, so normal cortisol levels feel terrible by comparison.
Continue down this path, and you reach the Exhaustive Phase. Like a phone on low battery mode, everything still works but at 30% capacity and not for long. You’re devoting everything to just getting through the day.
At FDN, we focus on six foundational systems that chronic stress systematically shuts down. We call them the H-I-D-D-E-N systems, and understanding what happens to each one under chronic stress is crucial for practitioners:
H – Hormones DHEA is your anabolic hormone: the one responsible for building you back up after cortisol breaks you down. This is how you pay off your cortisol credit card. But when stress is constant, DHEA steps back and says, “I’ll come back when it’s safe to focus internally, but right now we need to keep spending on the environment.” DHEA becomes chronically low, which means your healing potential becomes chronically low.
Then sex hormones get the message: “We don’t have enough resources to fund fertility right now.” Sex hormones plummet, taking motivation and joy for life with them. This is when you get to that neutral state where you’re thinking, “I have dreams I want to pursue, but it’s just too much effort. I’ll just watch Netflix instead.”
I – Immune Your immune system is expensive to run. Under chronic stress, it says, “I cost a ton of money, so I’m going to operate at 30% capacity and not for very long.” Now you’re getting sick often, it takes forever to heal, you can’t shake that cough, and if anyone around you is sick, you know you’re going down.
D – Digestion Digestion costs a lot of energy to function properly. When you’re spending everything on stress, digestion goes into low-power mode. Now you’re only digesting at 30% capacity. Even if you’re eating the cleanest diet in the world, you can’t use it. You’re not getting the building blocks to repair or the nutrients your body needs to power metabolic functions at full capacity.
D – Detoxification Detoxification is another huge system that’s expensive to run. When your body’s bank account is overdrawn from cortisol debt, detox says, “I don’t have enough money to find these toxins, bind them up, and effectively remove them. So I’ll put them in storage instead.” Your body shoves toxins into fat cells, brain tissue, and bones, creating a toxic backlog that makes you feel slow, gives you acne, throws off digestion, and impairs hormone production.
E – Energy Production Your mitochondria can’t function optimally when all resources are diverted to stress response. This leads to that “tired but wired” feeling where you’re exhausted but can’t actually rest.
N – Nervous System Sleep, mood, and cognitive function all suffer. This is where we see the brain fog, insomnia, anxiety, and depression that so many people struggle with.
The fundamental principle of FDN: These systems don’t operate in isolation. You can’t just say, “Oh, you have classic hormone symptoms, so let’s run a hormone test.” You miss immunity, digestion, detoxification: all the other systems contributing to what we call “Metabolic Chaos.”
This is why the “take this supplement for that symptom” approach rarely works long-term. You’re not dealing with isolated problems: you’re dealing with systemic dysfunction where multiple systems are compromised simultaneously.
Let’s look at three real clients to see how this plays out. As FDN practitioners, we use what we call “clinical correlation,” which means we never look at lab numbers in isolation. We always consider how someone feels alongside their test results.
Profile: 35-year-old male, broker at a mid-size investment firm, former athlete still crushing CrossFit workouts
Symptoms: Weight gain, trouble concentrating, loss of muscle mass despite rigorous workouts, headaches
Doctor’s Assessment: “Your results are unremarkable. This is normal aging.”
Lab Results:
The Reality: How do we know Adam isn’t on the left side of the stress curve going up into acute phase? His symptoms tell us everything. If he were on the way up, he’d feel amazing and wouldn’t be in our office. Instead, he’s on the right side coming down from peak production.
His cortisol pattern explains everything: sky-high morning cortisol makes him feel wired and anxious, the afternoon crash leaves him unable to concentrate (not ideal for an investment broker), and the nighttime spike disrupts his sleep.
Even though his DHEA looks “normal,” when we compare it to his cortisol level of 9, he’s clearly catabolic dominant. He’s breaking down faster than he’s building up, which explains why his intense CrossFit sessions aren’t building muscle: they’re just adding more stress to an already overloaded system.
Profile: 48-year-old court stenographer, recently divorced
Symptoms: Insomnia, fatigue, joint pain
Doctor’s Assessment: “Your results are fine. Everything’s in normal range.”
Lab Results:
The Reality: Caitlyn’s cortisol sum looks normal, but the distribution is completely dysfunctional. She can barely drag herself out of bed in the morning, crashes hard in the afternoon (imagine trying to accurately record legal proceedings when your cortisol is plummeting), and lies awake at night because her cortisol spikes just when it should be lowest.
She also has a relativity problem. When she was in the acute phase, she felt like Superman. Now that she’s in compensatory with “normal” cortisol levels, she feels terrible by comparison. Her DHEA is low, confirming she’s still in catabolic debt despite the lower cortisol numbers.
Profile: 43-year-old chef at a popular five-star restaurant, diagnosed with hypothyroid
Symptoms: Weight gain in hips and belly, trouble keeping up at work, depression, irregular menstrual cycle
Lifestyle: Working 60+ hours per week, consistently sleeping only 5 hours per night
Medical Status: Seeing a counselor, considering antidepressant medication
Lab Results:
The Reality: Maggie’s body is operating like a phone on low battery mode: everything still works, but at 30% capacity and not for long. Her thyroid has downregulated because there’s literally not enough energy in the system to maintain normal function.
The depression isn’t just psychological: it’s physiological. Her body can’t afford to fund optimal brain function. Even though her cortisol is very low and her DHEA is very low, she’s still cortisol dominant and in catabolic debt.
This is why understanding the stress curve is so crucial. Three people, three different phases, three different approaches needed.
Here’s why this matters for you as a health practitioner:
1. It explains why some clients plateau. If you’re not addressing the stress component, you’ll hit a ceiling on healing no matter how perfect the diet or supplement protocol.
2. It validates your clients’ experiences. When someone says, “I used to be able to handle so much more,” or “I don’t feel like myself anymore,” you now understand the physiology behind it.
3. It gives you a roadmap for intervention. Different phases require different approaches. Someone in the acute phase needs different support than someone in the exhaustive phase.
4. It highlights the importance of comprehensive testing. A single cortisol measurement tells you almost nothing. You need the full pattern plus clinical correlation.
At FDN, we don’t just talk about stress: we measure it. We use what we call “clinical correlation,” which means we never look at lab numbers in isolation. We always consider how someone feels alongside their test results.
We look at:
Then we address it systematically through our DRESS protocol:
D – Diet: Personalized nutrition based on lab findings, not generic “healthy eating” advice
R – Rest: Sleep optimization and recovery strategies tailored to your stress phase
E – Exercise: Right-sized movement for your current capacity (over-exercise is just as harmful as under-exercise)
S – Stress Reduction: Targeted techniques for your specific stressors: mental/emotional, physical, environmental, and lifestyle factors
S – Supplementation: Targeted support based on actual lab results, not guesswork
This isn’t about generic protocols. It’s about understanding exactly where someone is on the stress curve and what their body needs to heal.
Cortisol isn’t the enemy. A lot of people talk about cortisol as if it’s the villain—commercials make it sound like cortisol just makes you “old and fat.” That’s not what cortisol does. Cortisol is a vital hormone for navigating stress. The problem is chronic stress disrupting its natural rhythm.
Understanding the stress curve is diagnostic gold. It explains why clients feel the way they do and gives you a framework for intervention. Different phases require different approaches.
Clinical correlation is everything. You can’t just look at lab numbers in isolation. A cortisol sum of 5 might be “normal” to a doctor, but if your client feels terrible and the distribution is dysregulated, that tells you the real story.
You can’t ignore stress and expect lasting results. No matter how perfect your diet protocol or how targeted your supplements, chronic stress will cap healing potential. There’s a ceiling you’ll never break through if you don’t address the stress component.
The body’s systems are interconnected. You can’t just “fix hormones” without addressing how stress is affecting immunity, digestion, detoxification, and all the other H-I-D-D-E-N systems. This is why comprehensive testing and systematic protocols are crucial.
Metabolic Chaos requires a systematic approach. When multiple systems are compromised simultaneously, you need a framework like DRESS that addresses all aspects of healing, not just isolated symptoms.
If you’re ready to master functional lab testing and learn how to identify and address cortisol dysregulation in your practice, FDN provides the training, community, and ongoing support you need.
Because here’s the truth: your clients deserve more than “fine.” They deserve abundant vitality. And you deserve the confidence that comes from knowing exactly how to help them achieve it.
When you understand cortisol (really understand it), you hold the key to unlocking transformation for every client who walks through your door.
Ready to become the practitioner who always knows what to do next?
The answer lies in data-driven functional health. The answer lies in understanding that robust health isn’t just about the absence of symptoms: it’s about the presence of vitality.
And it starts with the hormone you can’t ignore: cortisol.
Discover how our comprehensive training program gives you the tools to master cortisol testing, interpretation, and protocols that get results. Because when you know how to test, you never have to guess. View an indepth case study here.
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Elizabeth Gaines
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There’s another mistake you might be making when it comes to relieving eye eczema symptoms.
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Your liver, lymphatic system, kidneys, and gallbladder are largely responsible for detoxification as well as processing and removing toxins like alcohol, pesticides, mold mycotoxins, and the waste products of your own metabolism. If your detoxification system is impaired by inflammation, toxins can build up in your body further perpetuating inflammation and causing swelling, rashes, pain, and damage to your organs.
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While vitamin C is arguably the best-known nutrient for immune defense, vitamin D has a lot to do with immunity, too. This fat-soluble essential vitamin supports a multitude of cellular functions that support the body’s immune response1—including protecting against pathogens and scavenging free radicals.
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I know have a tool kit that I can reach into whenever my body needs extra support.
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What you eat and drink can be the potential cause of autoimmunity, or the most nourishing influence in terms of helping to prevent or reverse autoimmunity. But what principles should you keep in mind when you eat for the long term? There are four main areas to address via nutritional modulation when you have an autoimmune disease: nutritional gaps, poor digestion, toxic backlog, and blood sugar spikes. Let’s dig into the importance of each:
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There are more than 80 types of autoimmune diseases, including Type I diabetes, arthritis, multiple sclerosis (also known as MS), and Graves’ disease. All of these come with their own unique symptoms. However, “The most common autoimmune disorder symptoms are fatigue, joint swelling and pain, skin issues, abdominal pain or digestive issues, and swollen glands,” explains board-certified regenerative medicine doctor Seema Bonney, M.D.
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For this study, researchers wanted to assess the impact of ginger on inflammation, namely looking at white blood cells called neutrophils, and further, neutrophil extracellular trap (NET) formation, known as NETosis. In the simplest of simple terms, when NETosis occurs, there’s a cell death of neutrophils and the body is subjected to inflammation as a result.
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Sarah Regan
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I felt waves of emotions (fear, relief, validation) before anger set in. My years-long mysterious condition was a full-fledged epidemic affecting 1 in 5 Americans, and I wanted to shout it from the rooftops so others wouldn’t have to go through this, too.
New to TikTok, I posted a video about the symptoms I was told were “normal” that turned out to be signs of autoimmune disease. To my shock, it racked up millions of views in a matter of hours, and thousands of comments from women reaching out with eerily similar experiences.
Search #autoimmunedisease on TikTok and you’ll get a very real and terrifying snapshot of this epidemic’s stronghold on women in America: over 1.1B video views, and countless thumbnails featuring the faces of twenty- and thirty-somethings just like me. We’re turning to TikTok for the autoimmune support our medical system isn’t giving us.
The autoimmune epidemic disproportionately wreaks havoc on women – 80% of patients are women1, and certain conditions are 16 times more common1 in women. They are one of the top 10 causes of death for women under 64. Despite all of this, autoimmune disease remains largely overlooked and misdiagnosed by healthcare professionals. On average, we have to see 5 different doctors and wait nearly half a decade before receiving the correct diagnosis. Almost half of us are told our symptoms are all in our head at some point along the way.
It was no coincidence when my sister, Claire, was diagnosed with autoimmune disease months later. She had similar, hard-to-pinpoint symptoms, normal labs, and dismissals from various doctors.
Getting healthy again quickly became a full-time job for both of us. We threw ourselves into learning everything there was to know about these diseases, and what evidence-based interventions would bring us the most relief. As we dove into the research, it became abundantly clear how underserved our community was and how desperately we needed better support and tools. So we decided to team up and left our full-time jobs to fill the major systemic gaps that exist in today’s standard of care.
Last year, we launched a virtual care platform called WellTheory to help women shortcut, and ultimately improve, the current path to an autoimmune diagnosis and receiving care. Our goal is to increase access to high-quality autoimmune care – making it affordable, empathetic, empowering, effective, and what we so desperately needed from the beginning.
But WellTheory is just one piece of the equation to reversing autoimmune disease. More broadly, it takes arming women with the resources to navigate the under researched and overlooked health issues that affect us the most – from fertility and menopause to autoimmune disease and beyond.
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Ellen Rudolph
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The diagnosis brought some relief, but it took years to learn how to manage.
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Rosie White
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From there, I knew I had to get on the ball, and get my proper care team together. That included a good neurologist, a therapist, and a supportive community.
Truly, I can’t emphasize enough how important it is to surround yourself with a circle of friends and family who can be there through every step. When I was first diagnosed, my husband told me this isn’t just your disease, it’s our disease. This type of caring and compassion is how I’m able to get through the really tough times.
I also began incorporating healthy lifestyle practices into my routine, which I’ve kept up to this day. First and foremost, moving my body regularly is key—if I don’t, I feel like I get super stiff and my mental health isn’t where it should be.
As I progressed on this journey, I also discovered music therapy—which has been around for an extremely long time. I began doing this type of work through MS in Harmony. They have different educational modules on their website led by board-certified music therapists. These exercises are designed to help people with MS support brain function, and potentially mitigate physical and mental symptoms. I’ve found this type of therapy to be so powerful.
Another thing I’ve had to learn is how important it is to be realistic about my bandwidth, and preserve my energy accordingly.
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Courtney Platt
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“Rheumatoid arthritis is caused by inflammation that leads to tissue damage in the joints,” emergency medicine physician Katie Golden, M.D. explains. “Research suggests that vitamin D deficiency may contribute to the development of rheumatoid arthritis5, as well as correlate with disease severity.”
According to a 2016 review from Clinical and Experimental Rheumatology, approximately 55% of RA patients6 are deficient in vitamin D. Additionally, research shows an inverse relationship between RA and vitamin D, in that activity increases when D status decreases.
“Other studies have suggested that increasing vitamin D intake may help alleviate symptoms,” Golden shares. “This makes sense, given vitamin D plays an important role in bone health.” She adds that most of the existing studies researching the connection between RA and vitamin D are small, so more research is needed.
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Stephanie Osmanski
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The cohort study analyzed a subset of 16,515 participants from the VITAL study and found that vitamin D levels increased less over a two year period in participants with higher BMI. Researchers hypothesize that this is due to a blunted metabolism and lowered amount of circulating (i.e., active) vitamin D in the blood in individuals with overweight or obesity.
Evidence shows a clear inverse relationship between adipose tissue and vitamin D status2, and this correlation subsequently impacts the likelihood that individuals with higher BMIs may reap the proactive health benefits demonstrated in previous studies (e.g., reduced cancer risk, cancer mortality, and autoimmune disease prevalence).
Does evidence show that maintaining healthy vitamin D levels can help reduce the likelihood of developing cancer or an autoimmune disease? Yes. However, current research also indicates that your body composition plays a massive role in how much vitamin D is stored in your adipose tissue (i.e., your body fat) versus the amount available for your cells to use.
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Morgan Chamberlain
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For this research, the study authors point out that AITDs are the most prevalent organ-specific autoimmune disorders. And given that vitamin B12 plays a critical role in proper functioning of the immune system, they wanted to look closer at the correlation between vitamin B12 deficiency and AITD.
In an observational study of 306 people, the participants were divided between those who were and were not deficient in B12, as well as those who had an AITD and those who did not.
Upon the researcher’s analysis of the data, they observed that patients with AITDs had “significantly lower” levels of vitamin B12 compared to those without. Further, those who were deficient in B12 also had significantly higher mean values of anti-TPO.
TPO, or thyroid peroxidase, is an enzyme normally found in the thyroid gland. With TPO antibodies, the body has a harder time keeping the thyroid functioning optimally.
“The vitamin B12 level correlates significantly to AITD,” the study authors conclude, adding, “The concentration of vitamin B12 should therefore be determined in patients with autoimmune thyroiditis as a diagnostic test with high sensitivity and good specificity.”
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Sarah Regan
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By Lauri Vargo, MD, assistant professor of dermatology, University of Nebraska Medical Center, Omaha, as told to Susan Bernstein
Vitiligo is largely a chronic disease with an unpredictable course, so treatment can be challenging for many people. Every person responds differently to different medications. First, I establish their goals and expectations for their treatment.
The mainstay of treatment for vitiligo starting out includes different topical creams, light therapy, and oral steroids. But the world of dermatology is ever-evolving, so new treatments are emerging now for vitiligo. If we need to, we can turn to a toolbox of newer treatments. There is a lot of good research and evidence behind some of our older therapies for vitiligo, and most dermatologists will start with these treatments.
What causes vitiligo is still largely unknown. We think there’s an autoimmune component to it. Vitiligo is typically associated with other autoimmune conditions. Going through your history is extremely important in vitiligo. Autoimmune thyroid disease is one of the most common conditions we see in someone who has vitiligo.
There are some newer therapies for vitiligo, and I typically use those when we haven’t seen any improvement with the older treatments. We have to weigh all of the risks and benefits of any treatment. We have to think about the potential side effects of any treatment, and cost is also a big issue for some patients.
There are many new and exciting medications in dermatology, but access to them can be a big barrier. Older therapies are better covered by insurance. I don’t want to offer someone a topical cream that they can’t afford when they go to pick it up at the pharmacy.
For vitiligo, we start with topicals and light therapy. We create each treatment plan on an individual basis because vitiligo can be a hard, frustrating condition to treat. People typically have lifelong disease and must continue their treatment. There’s no guarantee that we will be able to restore [skin] pigmentation or that your skin will return to normal.
One of the newer medications for vitiligo are janus kinase inhibitors, also known as JAK inhibitors. None of these are currently FDA approved for the treatment of vitiligo, but this will likely soon change.
With this new class of oral and topical medications, we have to address the potential side effects that come along with treatment.
Excitingly, we do have a topical version of one of these medications called ruxolitinib, which is currently used in eczema treatment. There have been some encouraging studies for it in the treatment of vitiligo, including facial vitiligo.
Typically, when we use topicals, we don’t get as concerned about systemic side effects. However, with these topical JAK inhibitors, including ruxolitinib, we are still unsure [how much of the drug you absorb through your skin] and how it could relate to potential side effects. That’s still a question.
There are other health risks for people who have vitiligo. Our melanocytes are cells that give us our pigment and protect our skin from the sun. So when you lack pigment-producing cells, you’re at greater risk for sunburn. I talk to all of my patients with vitiligo about how extremely important it is to keep skin covered and to protect your skin from burns. People with vitiligo don’t have that barrier to protect their skin from the sun’s rays.
I recommend that people with vitiligo or anyone use a sunscreen that’s SPF 30 or above, broad-spectrum, and water-resistant. It’s really important to apply enough sunscreen to your skin and to reapply it also. Most people don’t apply enough sunscreen to their skin. You need to apply 1 ounce of sunscreen at a time. That’s enough to fill a shot glass. You should reapply it every 2 hours or after sweating or swimming.
Ultraviolet protection factor or UPF clothing is another thing I recommend. You can find these clothes at many stores these days. This clothing provides extra protection from the sun. It’s really becoming popular with kids, too. Kids are wearing rash guards when they play outdoors. Because we have pigment-producing cells in our eyes, too, it’s important for people with vitiligo to use sunglasses to protect their eyes when they are out in the sun as well.
Our skin is our biggest and most visible organ. People with any skin condition are at increased risk of low self-esteem and a decrease in their quality of life because of their skin condition. People with vitiligo often are affected by this. I think it’s important for me to educate my patients with vitiligo, especially children, so they can explain what vitiligo is to other people, such as on the playground or in school. I want them to be able to feel comfortable with the skin they’re in. Adults with vitiligo, too, and all of us, are prone to self-esteem issues when it comes to our skin’s appearance.
I notice that a lot of people talk about vitiligo therapies as “cosmetic treatments” or vitiligo as a “cosmetic condition.” I feel that the term “cosmetic” suggests that we are taking something normal and enhancing it. But with vitiligo, we are treating your skin condition just as we would any other health condition you have.
If you have vitiligo symptoms, coming in for a diagnosis from your dermatologist is important. That’s because other skin conditions can mimic or look like vitiligo. There are some rarer conditions we want to rule out first. There are some allergic skin conditions that can look like vitiligo.
One thing I talk about with my patients is a makeup product called Dermablend to cover up skin. You may also use self-tanning products with dihydroxyacetone. Using a self-tanner product is completely OK if you have vitiligo. You can use it to cover up skin lesions if you want a more even appearance. If you go out and get a tan, you will only tan the rest of your skin.
I often recommend light therapy to people with vitiligo. This is one of my favorite treatments for this condition. It’s also called phototherapy. It’s a treatment that uses directed ultraviolet rays. Sometimes, when I recommend light therapy, my patients say, “Aren’t you a dermatologist? I thought the sun is bad for your skin!” But this type of light therapy should only be done as directed by a dermatologist.
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By Christine Morris, as told to Susan Bernstein
I was 16 when I was diagnosed with Crohn’s disease. It was 2004. I was just a very sick
kid. Even as a baby, my mom told me that I had to be on soy formula because I was lactose intolerant. When I was older, doctors told my parents I had cyclic vomiting syndrome. This was a permanent thing where my diaphragm was hyperactive. If I throw up more than once, I can’t stop. I would just go on and on until there was nothing in my stomach anymore. I had to get fluids at the emergency room. I learned as an adult that I can get ahead of this as it starts. I take a drug called Zofran. It makes me drowsy, but the good thing is that it dissolves under the tongue, so you don’t vomit it back up.
It all started with those warning signs. Doctors said, “Well, maybe she is just more susceptible to catching stomach bugs.” At 13 or 14, I suddenly took a turn for the worse. I developed an intestinal blockage. Crohn’s had been doing damage to my small intestine for years. I missed almost a whole year of classes during my sophomore year of high school. I had vomiting episodes and severe abdominal pain.
We joked sometimes that I had an alien in my stomach, because it would rise and fall so heavily. I wore sweaters and sweatshirts to muffle the noise it would make. Through this whole process, I saw multiple doctors and had multiple tests, including colonoscopies and endoscopies that didn’t find anything. It was terrible.
Doctors would say to me, “Well, maybe it is psychological.” At that age as a girl, they were always thinking that my symptoms might be caused by an eating disorder. This condition can stunt your growth, too. I lost so much weight. I was unable to absorb any food or nutrients. I wasn’t developing at the normal rate a teenage girl should. I looked 12 at age 15.
At 15, we finally decided to try to see a pediatric gastroenterologist in Atlanta. I grew up in Rome, GA. Unfortunately, I didn’t have access to high-quality care there. With a more severe disease, we wanted to be seen by a specialist at a research hub. We drove an hour into Atlanta to see a specialist at Children’s Healthcare of Atlanta at Scottish Rite. He was one of the greatest doctors I ever had and he knew Crohn’s so well. He looked at my hands and said, “Have you ever noticed that your fingernails are shaped like the back of a spoon?” He called this clubbing.
Eventually, the only way to definitely learn what was going on was to do exploratory surgery. In August 2004, they found exactly where my Crohn’s damage was located. It was just above the ileum, so too far in to be seen on a colonoscopy and too far down to be picked up by an endoscopy. Apparently, this had been developing for so long that inflammation had destroyed a whole section of my small intestine.
I was relieved to get a diagnosis. The big thing you want when you go through all of this is to have an answer for your symptoms and a plan. When I woke up after the surgery, they said, “You definitely have Crohn’s disease. It’s a permanent, chronic illness.” They did a resection of my intestine while I was in surgery, and they thought that hopefully, my disease would stay in remission with medications. It did for 6 years. Then, it came back with a vengeance in 2010. I had flaring, active disease again in my large intestine.
Crohn’s can appear anywhere in your digestive tract from your mouth to your large intestine. Colitis is only in your colon. The unfortunate thing about Crohn’s is that no amount of resecting can cover it. It was at that point when I realized the unfortunate cards I had been dealt. I realized that it would always be difficult for me to keep my Crohn’s under control.
Between 2004 and 2014, I was on seven different medications. At first, I only had to take an anti-inflammatory and an immunomodulator [drugs that treat the immune system to control Crohn’s flares]. That worked for 6 years. When I flared again, they put me on high doses of prednisone, a steroid: short bursts, but often. Then, I switched to biologics when nothing else would work. They worked longer, and initially, they were more effective. I have taken literally everything.
What did I wish I knew when I was younger? I definitely wish I had known there were resources available to help us understand Crohn’s and what I was going through. Obviously, the Crohn’s & Colitis Foundation of America (CCFA) does all it can to get information out there for patients. My family and I had no idea what this disease was or where to go for help. We never knew anyone else who had Crohn’s. We found out later that a cousin on my dad’s side had Crohn’s, too, but nobody else in my family had it.
Another thing I wish I knew was that, maybe for far too long, we thought the right doctor to see for my symptoms was my pediatrician. I really needed to see a gastroenterologist, because they specifically treat the GI system. Some of these doctors specialize in inflammatory bowel disease (IBD). I wish I had known that you could see someone who was also involved in Crohn’s or IBD research. They could have told us about clinical trials of new treatments that are not available to the general public yet but could be available for you if you have Crohn’s. These are medicines that can save lives.
I wish I had known that there were other resources to help people with Crohn’s. It was a very big issue for me that I was missing so much school. My school didn’t understand why I was missing classes. My dad had to go to get doctor’s records and letters to prove that I was out of school for legitimate medical reasons.
By 2010, I kept trying different biologics. I was learning to do home injections. I kept telling myself, “Well, it’s better than the alternative! Better than experiencing all of my symptoms.” Eventually, those drugs weren’t working either. I was going to the hospital more and more for vomiting, pain, and incontinence. These were signs that something was amiss. I had loose, bloody stool. I was running to the bathroom 25 times a day. I could not even finish a meal without running to the bathroom.
In 2014, I made the decision to do a diverting ileostomy [surgery to steer waste to a pouch instead of the inflamed gut]. They thought that giving my colon some bowel rest would help. I did that for a year, and I didn’t get better. My disease was severe. So, in 2015, I had permanent ileostomy surgery. They removed my large intestine and what’s called “the stump,” which is basically the anus. I don’t have a large bowel anymore. All stool comes through my small intestine to an ileostomy bag.
Thankfully, I worked for 9 years at CCFA. They were very understanding about patients working for them and had good insurance. I had to take short-term disability and max out my FMLA [Family Medical and Leave Act] leave. They were able to work with me, and I was able to keep my job. Recently, I was laid off due to the pandemic, and I now work at Habitat for Humanity.
On the first day of my current job, I had so much scar tissue built up that I had a severe vomiting episode. On my first day! I had to have surgery to remove scar tissue. Thankfully, with this job, I was open and honest with my boss about my Crohn’s disease. She was able to give me leave time in advance so I could get better. I love my job.
If I could give advice to someone who is first diagnosed with Crohn’s, it would be this: Have a support system, whether that’s your parents, a friend, or someone else. You will need people who can drive you to the hospital or for tests.
Crohn’s can be mentally taxing as much as physically taxing. Don’t underestimate your mental health needs. Get help or medication if you need it. I learned this the hard way. When I had surgery, they prescribed pain medication, which you need at first. But these drugs can cause depression, too. You don’t feel the physical pain for a while, but when you come off those drugs, you can feel so low. Trying to avoid that situation whenever possible helped me. I also take an antidepressant. Talk about all of your options with your doctor. Over-the-counter probiotic supplements also helped me, and I wish I had known this earlier.
One thing I’ve learned is that you must look at the whole body when you’re treated for an autoimmune condition like Crohn’s. My condition is more systemic. I have become very interested in the connection between the brain and the gut. They’re clearly connected.
Stress can affect your gut health. My Crohn’s flares happened to me during stressful times in my life, such as when I was graduating from high school and college and planning my wedding. Don’t overlook your mental health.
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Newswise — The Autoimmune Association, the world’s leading nonprofit organization dedicated to autoimmune awareness, advocacy, education, and research, is partnering with Gigi Robinson, a Gen Z patient advocate and creator economy thought leader. Gigi will deliver a lunch keynote session at the Autoimmune Association’s annual Autoimmune Community Summit taking place virtually October 21-22, 2022.
“I am super excited to be talking to such an amazing community of people looking to learn more and find new ways to navigate living life with chronic conditions,” Gigi said.
When she was just 11 years old, Gigi was diagnosed with Ehlers Danlos Syndrome, a connective tissue disorder, that leaves her very susceptible to injury. She has used her chronic illness as fuel for her passion for advocacy. Along with chronic illness advocacy, Gigi is also extremely passionate about mental health and body image. Having suffered from both in her teenage years, she strives to be a role model for the next generation, speaking directly to them via social media, podcasts, as well as numerous panels at colleges, high schools, and multiple nonprofits organization seminars.
The Autoimmune Community Summit, presented by the Autoimmune Association, is a virtual, free, two-day event designed for patients and care partners featuring educational and empowering sessions led by autoimmune experts including physicians, nurses, policy experts and of course, patient advocates. Attendees will hear about the most pressing topics that impact the autoimmune community, including clinical trials, health equity, access, complementary medicine, nutrition, coping mechanisms, medical and personal relationships, and more.
In her keynote, Gigi will discuss living life with a chronic illness, crucial communication skills, and mindset shifts that will inspire attendees to have a newfound perspective on their conditions.
Autoimmune diseases – comprising approximately 100 unique, chronic conditions – affects as many as 50 million Americans. These diseases include well-known conditions such as type 1 diabetes, multiple sclerosis, lupus, and rheumatoid arthritis, as well as others that are rare and difficult to diagnose.
“We are thrilled that Gigi is joining us for the Autoimmune Community Summit. She brings a unique perspective that will inspire and empower others living with chronic illness,” said Molly Murray, Autoimmune Association president and CEO. “As a social media influencer popular among the Gen Z population, Gigi will offer fresh insights and help create connections among the diverse autoimmune community.”
The full agenda, speaker information, session descriptions, and registration for the Autoimmune Community Summit can be found at go.autoimmune.org/AiCommunitySummit2022.
About The Autoimmune Association
The Autoimmune Association leads the fight against autoimmune disease by collaborating to improve healthcare, advance research, and support the community through every step of the journey. For more information about the Autoimmune Association, please visit autoimmune.org and connect on Facebook, Twitter, Instagram, LinkedIn and YouTube.
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