Vitiligo Reversal?

[TLDR: Let's try to take a detailed look at the autoimmune condition known as vitiligo with an eye to coming up with interventions that will reverse it. To learn more about a stem cell supporting nutraceutical that's reversed my vitiligo, click here.]

One of the things that mysteriously happened when I gave up my vegetarian/vegan ways and started eating something close to a proper human diet is that my vitiligo started reversing. I've told this story elsewhere - notably on my youtube - and loads of people want to work with me to reverse their vitiligo as a result. Until now, I haven't had the chance to really delve into the literature around how vitiligo works and why I'm able to achieve such good results. Researching and writing this blog is a way for me to continue learning and also to share what I'm learning with my vitiligo clients.  

Let's start with the obvious: vitiligo is an autoimmune condition where the skin loses its pigmentation - melanin - usually in patches. What I've seen in working with dozens of people with vitiligo is that there are three phases: a) an active phase where the patches are spreading and moving around, sometimes randomly, b) a passive phase where the patches are unchanging, and c) a reversal phase where the patches are becoming smaller and in some cases re-pigmenting. 

But why do some people (and it's not that rare, we're talking about maybe 1% of the population) develop vitiligo in the first place? (I found this paper particularly helpful in writing the following analysis.)

The first reason people develop vitiligo is that they have a genetic susceptibility. In other words you have to be born with certain genes that code for vitiligo. This is the case for anything - you can't do what your genes aren't coded to do - but I think we sometimes overstate the genetics. Genes are one factor, but many people have the genes for vitiligo but don't manifest the symptoms, perhaps because they don't have some of the triggers we'll mention below.

Second, vitiligo is an autoimmune disease. In autoimmune disease, parts of the immune system - in the case of vitiligo we’re talking about T cells, particularly CD8+ T cells, Resident Memory T cells and a few others - that kill the melanocytes which are the cells that store melanin. Some of the recent drugs, particularly a class of drugs called JAK inhibitors, use this pathway to target the cells that are killing the melanocytes. Understanding vitiligo as an autoimmune disease is important not just for goal of developing pharmaceutical therapies. We can also look at therapies that seem to help other autoimmune diseases - ketogenic diets for example - and see if those therapies may be employed in a particular case. 

Third, vitiligo can be triggered by certain forms of oxidative stress. Oxidative stress is something that’s talked a lot about but I think most people don’t understand what it is. In the course of living our lives, getting exposed to the sun, breathing polluted air, eating foods rich in sugars and so on, we get exposed to highly unstable compounds. What makes them unstable is that they have an odd number of electrons meaning that they make other parts of our body unstable, for example the lipids and protein that make up our skin. I’m not going to go into more detail here except to say that oxidative stress or the number of these compounds that we’re exposed to can play a role in vitiligo progression.

The degree to which oxidative stress can be a problem is determined in part by our fourth cause of vitiligo, which is essentially what part of the autonomic nervous system are we activating. You might have heard the terms “fight or flight” or “rest and digest”. These are essentially two different tones existing within our nervous system. To explain it quickly, imagine that you’re at home on a quiet evening relaxing with family and friends. What is your heart rate, blood pressure, and so on what are those things doing during such a time? Then imagine that you’re home alone, the lights aren’t working and you think there’s a burglar in the house. Now what’s happening to your heart rate and blood pressure?

In the sympathetic state, the body is tense, it is ready for action. The body is not thinking about things like healing the melanin cells. In fact, because the body is getting ready for potential injuries, blood is taken away from the skin and directed towards the brain and other vital organs.

10 thousand years ago, the stress response would not have been a problem. That’s because we were used to having an acute stress reaction. The acute stressors - like a lion or a snake - would trigger a huge stress response, but a short-lived one. After a few minutes, assuming we survived the encounter, we’d go back into our normal parasympathetic state.

But nowadays stress is low level and chronic. The stress of a dead end job, of having to make ends meet, of coping with the everyday demands of 21st century life, mean that many of us never properly enter the parasympathetic state. That kind of stress can make autoimmune diseases like vitiligo worse.

So we have four “root causes” of vitiligo: 1) genes, 2) an autoimmune response, 3) oxidative stress and 4) sympathetic tone (the stress response). If we want to reverse our vitiligo, which “root cause” should we focus on?

Well clearly not 1. If you have already been diagnosed with vitiligo, you have the genes for it. And for me the clear takeaway from 30 years of trying to develop gene therapy for cancer treatment is that targeting genes is a dead end. 

What about 2? Is is possible to retrain the immune system? The answer is, at present, unknown. There are some potentially promising drugs including the aforementioned JAK inhibitors that are targeting this pathway. As yet, those drugs are either unproven or show only modest or temporary benefits. And like any other pharmaceutical intervention, those drugs include some side effects; the decision about whether the costs outweigh the benefits is highly individualised and is a matter between you and your doctor.

Which leaves us with 3 and 4. In terms of sympathetic tone, it is probably always a good idea for individuals to be taking some kind of action to improve their ability to tolerate stress and thereby reduce their burden of chronic stress. What that means in terms of strategies may vary from person to person - certainly things like meditation, breath work and so on may play a role. Things like cold water plunges, exercise, sauna and other acute stressors may also play a role. For some people, getting into a proper sympathetic state through these acute stressors may help to get into a parasympathetic state afterwords. With that particular strategy we need to be a bit careful though. Some people do so many cold plunges or marathons without letting their body recover that it becomes counter productive.

But for me the real key here is the oxidative stress. There are many things that are known to cause oxidative stress, but one of them certainly is the diet. In particular glucose, fructose, and high carb diets are known to increase the burden of oxidative stress on the body. Now one can counter that there are lots of things that increase oxidative stress including high fat diets, but ketogenic diets - meaning high fat diets that actually raise ketone levels in the blood - reduce oxidative stress. 

So does that mean that ketogenic diets "cure" vitiligo? Not necessarily. As mentioned above there are many factors at play and one can't assume that a ketogenic diet would address all of them. But in my practical experience, they're a good start. 

Another good start might be to enhance the availability of stem cells. Adult stems cells are cells we all have that can become anything - including melanated skin cells which are necessary to reverse vitiligo. I've recently started taking this product from Cerule and it's the first time I've actually seen complete disappearance of a vitiligo patch. 

I'll write more about research showing that stem cells may have a role to play in therapy for vitiligo and other autoimmune disease. For now, the main takeaway is this: vitiligo has multiple "root causes", and some of those can be triggered by high carb diets. Moving towards a high fat, low carb or even a carnivore diet can be a powerful intervention for reversing vitiligo.