Exercise and a proper diet are often cited as the keys to good health. This is true for all people, but in particular for those of us with a serious illness such as Pemphigus. Not only does the disease itself cause problems, but the medications involved in treating it pose an added risk.

We know how to exercise, but how do we determine what the proper diet is?

Van Lenten

There is such a variety of viewpoints that the answer to this question has become lost in a sea of confusing and contradictory information. Sales pitches abound, with promises of a longer, healthier life, but there are arguments even among professional nutritionists concerning the basic issues, such as hether or not supplements are necessary to maintain good health, or whether its better to go for a high carb or low carb diet. Its hard to make sense out of all the conflicting statements, and what is in this year, might be looked at with suspicion next year.

We know several things about pemphigus that should be taken into account when trying to meet our special nutritional needs: the first is that prednisone is required to treat all forms of pemphigus unless the patients cannot tollerate it. We also know that prednisone depletes calcium, and that calcium loss can lead to osteoporosis, elevated levels of stress, and other complications associated with a deficiency of this essential mineral. Common sense would indicate that if prednisone depletes calcium, then calcium supplements should go hand in hand with the use of prednisone. That, in fact, is why some of our leading dermatologists are beginning to prescribe at least 1000 mg of calcium per day, plus 400 I.U.s of vitamin D (which helps in the absorption of calcium).

Adding calcium supplements to our diet also aids in our ability to handle stress which has been listed as one of the possible causes of pemphigus, and it helps in the absorption of zinc.

Zinc is an important element of the healing process. It is used most often in wound healing and severe burn cases. Anyone who has experienced the burning sensation of open blisters resulting from pemphigus, and lived with the lesions they leave behind, will understand that zinc is probably the most important nutrient to consider adding to your diet next to calcium. A good source of zinc can be found in most stress tabs, with an average daily dose of 22-25 mg per tab. According to Dr. Carl Pfeiffer, a leading expert on mineral deficiencies, Stress of any kind depletes the body of zinc.

There are few things in life more stressful than pain, and since stress causes a loss of zinc, there is a double jeopardy associated with a major illness such as pemphigus.

Not only are most patients deficient in zinc to begin with, and having difficulty handling stress on a day to day basis, but the onset of painful symptoms, and the mental strain of knowing the nature of the disease, causes an even greater loss, which may prolong the duration of the illness and slow the healing process.

There are certain specific dietary considerations to take into account as well. There are several food groups which are possible triggers of pemphigus, including foods that contain garlic, onions, leaks, and peppers.

In an interesting study by Dr. Vincent Ruocco and his associates, Pemphigus and Diet: Does a Link Exist, it was found that some cultures in India, where the incidence of pemphigus is high, ingested a great deal of these foods and used them for medicinal purposes. Dr. Ruocco mentioned in the introduction to his study that these foods were found to have a chemical structure similar to drugs that have been found to induce pemphigus. The implication, of course, is to avoid these foods and eat a less caustic diet.

Salt is also an item that needs to be limited. Prednisone causes a loss of potassium, leading to fluid retention and possible elevation of blood pressure, and also interferes with the release of sodium through the urinary tract, causing a strain on the kidneys. It is another source of stress that needs to be eliminated as much as possible.

Weight gain is not only a social issue, it is a threat to our overall health in and of itself. Although it is sometimes difficult to control, and compounded by the water-retention, bloating, and moonface that sometimes accompany the use of prednisone, it is always best to avoid refined carbohydrates, such as cookies, candy, cakes, and pies. These foods are very high in calories, and relatively low in nutrients, which is why they are referred to as empty calories. To avoid the stress of being overweight, eat smaller portions and count calories, not carbs.

The types of foods we eat also become an issue when the mouth is affected by pemphigus. A blender is an important addition to any kitchen, and is a good way of make sure that we eat a variety of foods and are not deprived of enjoying them while we get through this difficult period.

Although the exact nature of what makes a proper diet is difficult to determine, we at least know from our understanding of pemphigus and prednisone what not to eat. That is a good starting point for determining the nature of our diet, and discovering what foods might actually be helpful.

Originally published in the February 2004 issue of Recovery.