Stelara and Psoriasis

Last year, I started getting a shot called Stelara for my psoriasis.  Psoriasis is an auto-immune disease.  Where normal skin regenerates every 30 days, in the patches where there is psoriasis, that process can be sped up to every three days, making you have awesomely dry skin.  It is commonly found on the joint areas, like elbows and knees.  However, it can also grow in places where there was trauma to the skin, so imagine needing to be very careful while shaving.  I am very lucky that, on me, it generally sticks to my elbows and arms.  I also don't have it on my scalp, so I consider myself very lucky.  I have met people with it over almost every inch of their body.  I cannot even imagine how painful that would be.  Psoriasis is an incurable and not well-understood disease.    

Anyway, psoriasis is especially difficult if you're a pole dancer because traditional "fixes" include very heavy creams and ointments.  Makes you slide right off that pole.  If you had told me five years ago that I would not be slathering lotion on myself on a daily basis because I would be a pole dancer who needed my skin to stick, I would have laughed at you.  Some medications are also steroids and thin your skin.  You don't need your skin to slide right off on the pole either.  Another helpful treatment for psoriasis is exposure to the sun (helpful for skin cancer as well).  Since I didn't have time to come to the doctor's office for light box UV treatment, I did talk him into allowing me tanning booth time as an alternative.  Even though it's not the right kind of UV exposure, it still helped a little.  I also found that when I lost weight, my psoriasis was almost completely gone.  Stress is also a factor and my psoriasis coming back also could have been connected to very stressful things going on in my life around the same time. 

My biggest concern about taking Stelara is that it is an immuno-suppressant.  The last thing I need, especially now that I sit on BART almost two hours a day with lots of icky germs and coughing people, is to be more prone to catching a bug.  I have found, though, that staying somewhat active and taking echinacea have really kept me pretty healthy.  My doctor did say he didn't notice people getting sick more often on Stelara, but that they may stay sick longer if they did happen to catch something (and I noticed the same thing when I first started the shot but feel like I haven't been really sick in quite awhile -- knock on wood, that was not a challenge, Universe!).  I find if I get that feeling of itchy throat or a couple of sneezes, I take some Zicam and go to sleep early and I'm good to go.  

The bigger issue has been that my insurance company now deals with my shot differently (thanks, Obamacare!!).  It is no longer a "pharmacy" item, it is a "medical" item.  So it takes forever to get it approved and they are often late in getting it to me.  I only need to get this shot every three months but it is commonly two to four weeks late thanks to the incompetency of the insurance company and the crappy pharmacy they force me to use.  When the shot is late, the psoriasis starts to return and it often won't fully clear that cycle.  Getting the shot is also time consuming.  I could give myself the Enbrel and Humira shots at home.  Stelara requires me to go into the doctor's office.  And the office is not near my home or work, so it's one more thing on the to-do list.  That kind of sucks.  

Anyway, so if you want to check out some really bad before pictures, you can check out the link above (or you can look here).  And here are a couple of photos from this month.  My before-shot photo on November 4th and my after-shot photo today (the 19th).  Yeah yeah, you probably can't tell a huge difference but I can!

"Before"

"After"

Stelara For The Win

Last March, I wrote about switching to Stelara shots for my psoriasis.  I was worried about Stelara.  It is a pretty heavy immuno-suppressant, but as a pole dancer unable to use heavy creams or ointments to treat my skin condition, I was willing to give it a chance.

Well, eight months in, I have to say I like it!  I had my first shot in early April of 2012.  In the beginning, I got a shot every month.  Now I only go in every three months.  With Enbrel and Humira, I was able to give myself the shot at home with an epi-pen type device.  With Humira, I do have to go into the doctor's office, which is a little less convenient.  It also forces me to pay an office visit co-pay.  However, I have been able to qualify for assistance from the manufacturer of Stelara, so I haven't had to pay a co-pay for the drug at all. 

About two shots ago, my insurance changed how it handled the billing of the drug, so I was a month late in getting that shot.  I noticed a huge difference.  Even when I finally got the shot, my skin never fully cleared that round.  However, with the next shot, my skin went back to being clear. 

I haven't noticed being sick more often.  I do notice staying sick longer, though, if I happen to catch a cold.  So I try to be very careful around other sick people and I take echinacea to hopefully boost my immune system (although, one would wonder if taking something that supposedly boosts your immune system when you're taking something to purposely suppress it is counter-productive). 

I did find out the hard way how expensive a Stelara shot is if you lose your insurance.  I was told in September to look for a new job.  My former boss had offered to pay my medical insurance for the month of October.  He then "forgot" and canceled it without telling me.  The pharmacy mailed the shot to my doctor's office (waaaay earlier than it needed to be....Curascript mail pharmacy is really a shitty pharmacy; if anyone is looking for a mail pharmacy, I do not suggest them).  The claim was denied by my insurance company and I saw online that I was being charged almost $12,000 for that shot.  I opted for COBRA (with an over $700 premium) to avoid that bill. 

Anyway, these days my skin is pretty clear, and I don't have the lung problems like I did with past medications.  I am overly aware of people who are sick around me.  I also have to be super careful because I am more apt to catch tuberculosis.  But for the most part, I just live my life and am happy to have "regular" skin again. 

March 25, 2012

April 5, 2012

April 13, 2012 (after first shot)

May 3, 2012 (day of 2nd shot)

The Psoriasis-Stelara Modification

So catching everyone up on this whole mess...I started Enbrel in July 2011 to help with my psoriasis.  Pretty much nothing happened.  I switched to Humira in October and pretty much nothing happened (except I started getting a bunch of upper respiratory infections).  You can see my last Big Bang Theory themed update here:  http://lolorashel.blogspot.com/2012/01/psoriasis-humira-conundrum.html

So, now...drum roll please...I'm going to try Stelara.

I don't want to take Stelara.  

Why am I doing this to myself?  All of these shots are immune-suppressants that cause me to get sick.  All for clear skin?  It sucks because my normal therapy for psoriasis is super thick and greasy lotions or ointments.  Well that just doesn't work for pole dancers!!  [Insert foot stomp and minor tantrum here.] 

Some of the serious side effects of Humira are:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); black, tarry, or bloody stools; blood in the urine; burning, numbness, or tingling; butterfly-shaped rash on the nose and cheeks; change in the appearance of a mole; chest pain; confusion; fainting; fast or irregular heartbeat; mental or mood changes; muscle pain or weakness; new or worsening joint pain; open sore that does not heal; persistent pain, swelling, or redness at the injection site; red, swollen, blistered, or peeling skin; severe or persistent headache or dizziness; severe or persistent stomach pain; shortness of breath; signs of infection (eg, fever, chills, or persistent sore throat; persistent cough; flu-like symptoms; warm, red, or painful skin; increased or painful urination); swelling of the ankles, hands, or feet; tremor; unexplained weight loss or weight gain; unusual bruising or bleeding; unusual lumps; unusual skin growth or other skin changes; unusual tiredness or weakness; unusually pale skin; vision changes; vomit that looks like coffee grounds.

Sounds pleasant!  

Some of the side effects of Stelara are:

Stelara may increase the risk of infections and reactivation of latent infections. Serious bacterial, fungal, and viral infections were observed in subjects receiving Stelara.  Serious infections requiring hospitalization occurred in the psoriasis development program. These serious infections included cellulitis, diverticulitis, osteomyelitis, viral infections, gastroenteritis, pneumonia, and urinary tract infections.

Individuals genetically deficient in IL-12/IL-23 are particularly vulnerable to disseminated infections from mycobacteria (including nontuberculous, environmental mycobacteria), salmonella (including nontyphi strains), and Bacillus Calmette-Guerin (BCG) vaccinations. Serious infections and fatal outcomes have been reported in such patients.

Stelara is an immunosuppressant and may increase the risk of malignancy. Malignancies were reported among subjects who received Stelara in clinical studies.

One case of reversible posterior leukoencephalopathy syndrome (RPLS) was observed during the clinical development program which included 3523 Stelara-treated subjects. The subject, who had received 12 doses of Stelara over approximately two years, presented with headache, seizures and confusion. No additional Stelara injections were administered and the subject fully recovered with appropriate treatment.

Serious infections and possibly cancer?  Sign me up!  I'm also nervous because it specifically says they don't have a lot of information on people who get allergy shots and I'm over three or four years into my allergy shot commitment.  

I feel like I'm on a train that I can't quite get off yet.  I was hoping I'd lose a bunch of weight and not need anymore medications.  That has not been the case.  In fact, now that I'm reading more about Humira, that may have been one of the things working against me.  I am a little more nervous about Stelara because, even though it has been approved by the FDA, there are no long term studies on how it affects people.  In ten years, my arm could fall off and I may have to say, "oh I'm guessing that was because I took Stelara back in the day!"  At least I am sticking with somewhat known medications.  My doctor did offer to put me in a study, which would have given me free treatment.  But then I'm a human lab rat.  No thanks!!  

Anyway, here are some photos to show how this stupid disease can look even from day to day.  One day I'm horribly red and disgusting.  The next day, not so bad.  But I still have not had clear skin in almost two years -- and this is the worst outbreak I've had in longer than I can remember. 

March 3 (before my Humira shot):

March 4 (day after final Humira shot):

March 5 (two days after Humira):

The Psoriasis-Humira Conundrum

I've been watching too much Big Bang Theory.  I freakin' love that show.  I just ordered a bunch of books off Amazon to help me learn bigger, cooler, nerdier words.  :-)

So I'm on here whining about my psoriasis about once a month, I guess.  I first started Enbrel shots in late July.  This was supposed to be the miracle drug.  You shoot yourself up, suppress your own immune system, and VOILA!  Clear skin!  You can check out my two-week update which includes photos here:

http://lolorashel.blogspot.com/2011/08/enbrel-and-psoriasis-two-week-update.html

That wasn't working for me so my doctor then changed me to Humira.  Let's see if we can make you even more tired and apt to catch colds....all in the name of beautiful skin!  You can read that October post here:

http://lolorashel.blogspot.com/2011/10/psoriasis-and-humira.html

So now I am four months into the Humira shots.  Sure, my skin is clear-er than it was.  But its not completely clear.  At my last appointment (barely two weeks ago), my doctor brought up the possibility of taking another step up and trying a drug that really has only been around for a couple of years.  You can read about that here:

http://lolorashel.blogspot.com/2012/01/found-motivation.html

So basically, be an experimental rat.  I'm thinking no thanks.  You want to know when my skin was at its best?  When I was thinner.  So I am going to stick to this Paleo plan, the Twirly Tuff workout and probably just stop taking the medication altogether.

I am going to include a couple of recent photos.  From the pictures, it looks pretty clear.  But a lot of the skin is still rough and some days, its redder than others.  I really have not had a break-out this bad since before my weight loss.  So I have to believe that losing weight is the key -- not drugging myself up.

And here's a picture from June 2011:

Progress?  Yes.  Full victory?  Not yet.

Psoriasis and Humira

So I am currently three months into taking Enbrel shots for my psoriasis.  Enbrel is an immune system suppressant.  My last update was at two weeks:  http://lolorashel.blogspot.com/2011/08/enbrel-and-psoriasis-two-week-update.html

At two weeks, everything was going well.  My psoriasis had easily gotten 50% better.  But for the last two and a half months -- nothing.  So my doctor is switching me to Humira. 

According to my doctor, it goes like this...

Side effects:

Placebo:    ***
Enbrel:      *****
Humira:    ******

Effect of medication on psoriasis:

Placebo:   ***
Enbrel:     *****
Humira:   **********

So if that makes any sense...there might be a little more chance of side effects (oh, only infections like TB or cancer like Lymphoma), but a much higher chance of the medication working.  The only side effects I really dealt with while on Enbrel were headaches and being sleepy.  Mostly those happened in the beginning and then tapered off.  Maybe that meant the drug wasn't working??  Since the shot is given directly into the skin, my gastric bypass wouldn't have anything to do with absorption issues. 

Anyway, I took my last Enbrel shot on Monday.  The Humira comes on Friday.  I was taking two Enbrel shots a week.  With Humira, I take two shots on day 1, one shot on day 8, one shot on day 22, then one shot every other week.  So that will be nice...not having to shoot myself twice a week.  It burned and I wasn't a fan.  I just hope I don't have to deal with being super tired and getting headaches again.  That wasn't fun.

I did find an awesome lotion made by a local guy at a Farmer's Market.  It has been helping a lot this week.  Although psoriasis is a "smart" disease and it gets used to whatever magic product you find and it eventually stops working so who knows how long it would have helped anyway.  The stress in my life hasn't gone down at all (if anything, it's going up), and I'm sure that's not helping the disease either. 

 So let's see how Humira works!

Latest photo (certainly better than when I started, and looking especially good today because I cheated and put on lotion even though its a pole day):

Psoriasis and back pain?

Today I had the four-week check-up with my dermatologist regarding Enbrel.  My doctor's office asked me to participate in a survey for people with psoriasis.  One of the questions asked had to do with back/hip pain not associated with an injury that actually gets better with exercise instead of worse. 

Interesting.  You mean like MY back and hip pain?  The pain came from nowhere and I feel tons better when I'm working out consistently.  I've always wondered how that works.

I asked the significance of that question.  The PA said that it could be psoriatic arthritis.  She said I should definitely tell (remind!!) my orthopedist that I have psoriasis.  They did an x-ray and said I didn't have regular arthritis, but I don't know if the test for psoriatic arthritis is different. 

Anyway, I just found that interesting.  She did also mention that Enbrel also treats psoriatic arthritis, so I may notice that my hip and back pain get better during the time I'm on the medication.  I definitely feel like I'm not in as much pain as I should be after a couple of weeks off at the gym (and then a great/hard Twirly Girls class last night).  So, maybe THAT'S where my hip and back pain come from!

It's good information to know and now I have even more motivation to exercise.  I signed up today for pilates reformer classes at The Absolute Center in Lafayette.  I had a great Twirly Girls class and felt like I really need to get my core in shape.  Starting in early September, I will take classes twice a week for five weeks.  Hopefully I have the money to continue when this series is over!

Still motivated...WOOHOO!!!

Enbrel and psoriasis -- two week update

So I am officially two and a half weeks into my Enbrel shots.  I give myself a shot Monday and Thursday nights.  It's pretty easy.  It looks like an epi pen.  I hold it against my thigh and click a button.  It takes about 10 seconds (which is a loooooooooooooong time when you aren't enjoying whatever is going on) and then it clicks again and I'm done.  Between the Chilidog and me, there are sharps containers ALL over the house.  

I feel pretty good.  The shots do make me a bit tired and I have little red spots on my thigh for a few days after the shot.  But otherwise, I haven't gotten sick or any of the other really bad side effects that people online complained about after their fourth shot (which I took last Monday...tonight is my fifth shot).  

The nurse said I should notice an improvement after about a month but I can already see small improvements.  My arms are still pretty dry-looking but better than they were.  My face is almost completely cleared up.

So here are some pictures to show my progress.  And one of the ugly bump on my thigh.  It itches a little and you can actually feel a bit of a bump on the muscle.  I'm pretending it's just awesome muscle definition on my amazing thunder thighs!  Thunder.  Thunder.  THUNDER THIGHS HOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO!

June 17, 2011

(from 365 blog)

August 4, 2011

(about a week in)

August 9, 2011

(I was on the river over the weekend and the sun and water probably contributed 

to my skin actually looking pretty decent)

 August 11, 2011

(after four shots)

Injection site bump

(the band-aid was from Monday's shot, and the red spot was from the 

previous Monday's shot -- you alternate which thigh you shoot each time)

So, nothing to get super excited about yet.  My skin isn't as red but it's still pretty dry.  Doing Twirly Girls is REALLY rough because I can't use any of my medications or moisturizers before pole.  So Wednesday to Thursday, my skin is usually pretty scaly and nasty.  I am hoping to have clear skin within the next month or so, though! 

Psoriasis and Enbrel

So my insurance approved me for a medication called Enbrel.  It's a weekly injection that you give yourself to help control psoriasis.  It is also used to treat a couple of types of arthritis.  It works by lowering your immune system.  Psoriasis is like having an amped up immune system -- to the point that your own immune system starts attacking your body and you end up with plaques where skin starts growing too fast.  I won't lie -- I'm a little nervous.  They say that you don't usually get sick more often...you just might stay sick a little longer if you do get sick.  But I'm desperate so I'll try it.  The patches on my face are especially bothering me.  I had to get tested for tuberculosis, HIV and Hepatitis B before I was approved.  Rob works somewhere that puts him at a higher risk for TB, so I guess I have to hope he doesn't bring it home because I will be more likely to catch it now. 

I am hoping this will clear up my psoriasis.  I recognize that this is mostly for vanity.  I'm not contagious but I certainly feel like people look at me like I am.  People constantly ask me what it is.  I think you take the series of shots for a year or more.  But I have heard that some people will have clear skin for years past that.  I am keeping good thoughts that it will work for me with as few side effects as possible. 

Project 365: Day 3

I tried to get a "good" picture for today's post.  There is no "good" picture of this crap.  My psoriasis.  It has been pissing me off lately.  The sun is good for killing it...and now that the sun it out, I certainly hope it starts getting better.  The doctor has me slathering four or five different chemicals...I mean medications...just to keep it this "good."

It mostly affects my elbows, down my arms to my wrists.  I sometimes get patches on my knees, face or other parts of my body (especially if I cut myself), but it mostly affects my elbows.  Psoriasis is an autoimmune disease that causes skin cell to grow more quickly than normal, so it leaves dry patches of skin.  It generally starts on the joints, and some people end up with psoriatic arthritis.

You cannot catch it from me, not that some people care to ask or understand.  Most people think its poison ivy.  When I worked at Sears Portrait Studios as a teenager, I had parents refuse to let me photograph their children.  I have been to a day spa for a massage where the therapist refused to massage me without gloves because the red spots meant blood, which meant she could catch HIV.  *sigh*  For the most part, I get it and don't bother trying to explain.

Today, my psoriasis is irritating me, so I am sharing my ugliness with the world.  I guess in the whole scheme of things, I could have a lot worse wrong with me.  Oh yeah, here's some good news:  my face isn't nearly as bad as it has been in the past couple of months, so that makes me happy.  However, I have three different topical medications and an anti-inflammatory antibiotic pill that I've been taking for the last three months.  Maybe the recent sun exposure is helping too.  :-)

Gluten sensitivity and psoriasis

I ran into a friend last night after Rob and I took a walk around the neighborhood.  She noticed a red spot on my face and asked if I had been in the sun too much.  Nope.  Just psoriasis ruining my life.  I tell her about how much I've been to the doctor lately and how many different medications I'm on just to keep it this crappy looking.  I forgot she also had psoriasis. 

She tells me...I went gluten-free and my psoriasis is essentially gone.  She shows me her elbows.  There is nothing there! 

YAY!  Ugh.

You know all about me and trying to cut something completely out of my life.  How'd that whole no-yeast thing turn out?

I know a couple of people who have gone gluten-free and it has done wonders for them.  This is definitely incentive to try it.  This is the worst my psoriasis has been in probably 8 years.  But I so lack willpower and cutting something out just makes me want it more.  Gluten/wheat is in EVERYTHING.  Even frickin' Doritos CORN chips have wheat in them! 

http://www.dermaharmony.com/psoriasis/celiacandpsoriasis.aspx

Overview

A growing body of evidence is beginning to show that there is a connection between psoriasis and gluten intolerance (celiac disease). For a small percentage of psoriasis sufferers there exists an important connection between what they eat and what happens to the skin.
When wheat flour is mixed with water, a complex protein called gluten develops. Gluten is what gives the dough of wheat an elastic structure that allows it to be crafted in a variety of ways. If wheat is high in gluten content it is called "brown" or "white" If it is called "weak" or "soft" the gluten content is low. If you are sensitive to gluten, avoiding wheat products containing gluten is the only way to prevent reaction.

About Gluten Intolerance

An estimated 2 million Americans suffer from an allergy that many don't even know exists. Celiac or gluten allergy could be the most common allergy afflicting Americans today. Recent research has revealed that an undiagnosed gluten allergy can be especially problematic for those suffering from psoriasis and other skin conditions. Though occasionally patients are asymptomatic, usually symptoms mimic other conditions, and often physicians misdiagnose it as Irritable Bowl Syndrome (IBS). The wide array of symptoms include:

• Diarrhea
• Bloating
• Headaches
• Canker sores
• Fatigue
• Irregular Menstrual Cycle
• Joint Pain
• Sleep Irregularity

Dermatitis Herpeformis, a persistent, itchy rash with red skin and watery blisters often appears on the knees, elbows, backs and buttocks of individuals with wheat allergies.

Celiac disease is a genetic condition where the body reacts to giladin, a gluten protein found in wheat, barley, and rye, by producing an enzyme called tissue transglutamise. The enzyme triggers an inflammatory reaction in the bowels which eventually leads to flattening of the villi lining the intestinal wall.

Villi, are finger like protrusions which line the sides of the intestines and filter out nutrients as waste passes through. When villi become flattened and unable to function, malnourishment can occur from vitamin deficiencies. If intestinal distress, and malnutrition aren't motivation enough, the Mayo Clinic website states that gluten intollerant people who continue to consume gluten are "at higher risk of developing cancer, especially bowel cancer or intestinal lymphoma."

Often celiac patients seek help from their doctors because they are suffering from mal-absorption problems and don't yet know the root cause. The most commonly seen problem is anemia due to lack of iron in the blood. Symptoms of anemia include: dizziness, insomnia, pale skin, and difficulty concentrating. Other often seen problems stem from lack of folic acid, B-12, Calcium and Vitamin D, all of which have troubling symptoms and some, like calcium deficiency, can lead to irreversible conditions such as osteoporosis. Those severely deficient in Vitamin K may experience abdominal bleeding. Because the villi are virtually stripped away, or severely incapacitated, often harmful bacteria build up in the small intestine causing a host of other problems such as Candida and/or Leaky Gut.

Celiac and Psoriasis

Since both celiac disease and psoriasis are conditions which affect the auto-immune system, research seeking connections between the two has recently increased. A 2004 article in Psoriasis Advance, a magazine published by the National Psoriasis Foundation, conducted an interview with Gerd Michaelsson, M.D., Ph.D, who in 1993 preformed a study which found that some patients with psoriasis also had one of the markers of celiac disease; increased antibodies to gliadin. Dr Michaelsson stressed that "most patients with psoriasis are not gluten intolerant. However, there is a subgroup with silent celiac disease/gluten intolerance and it is important to identify these patients, as there is a chance to considerably improve the skin lesions on the gluten-free diet (GFD). In some patients there may be a total or nearly total clearance on the diet. When gluten is reintroduced there is a flare up of the psoriasis." Dr. Michaelsson thinks that it is possible that some celiac sufferers may be predisposed to psoriasis, but have not had any problems since they adhere to a strict gluten-free diet.

An article in the April 2007 issue of World Journal of Gastroenterology, by L Abenavoli, L Leggio, G Gasbarrini, G Addolorato, seems to corroborate Dr. Michalessons research. Psoriasis patients who tested positive for the markers that indicate celiac and were put on a GFD. Researchers noticed "thirty of 33 patients strictly complied with GFD, have showed a significant decrease of psoriatic lesions." Celiac is a systemic disease, and not one that is isolated simply to the digestive system. The link between psoriasis is some people is clearly tied to a gluten-sensitive enteropathy (pathology [disease] of the intestine). While the cause for psoriasis still remains unknown, and may in fact be the result of numerous factors, celiac is a genetic condition.

The Psoriasis foundation quotes yet another researcher, Dr. Kruger who thinks that the link might just be odds "simple math dictates that it would be surprising if there weren't some people with both diseases." Indeed," Dr. Krueger says, "there is a certain small percentage of people in the general population with celiac disease, and a certain small percentage of people in the general population with psoriasis, so one should not be surprised to find a significant number of people who have both. Notwithstanding, many psoriatics go into remission when adhering to a GFD.

For many, the link between celiac and psoriasis is common sense. Digestive specialist Elizabeth Lispki, Ph.D., CCN asserts in her book Digestive Wellness, that diet is the cause of most auto-immune afflictions ranging from psoriasis to colitis. Dr. John O.A. Pagano and Deirdre Earls, RD, psoriasis specialists, believe that changing what we eat can help to alleviate psoriasis outbreaks.

At DermaHarmony we offer "Your Healing Diet, a Quick Guide to Reversing Psoriasis and Chronic Diseases with Healing Foods" by Deidre Earls RD, LD, an informative book which clearly outlines rules for an effective healing diet, to our clients. Though these diets don't rule out wheat completely, they suggest it be consumed occasionally in whole grain rather than processed form. All stress the importance of wheat avoidance for celiac sufferers. The consensus among these authors seems to be "healthy gut, healthy skin."

http://www.dermaharmony.com/skinnutrition/default.aspx

http://en.wikipedia.org/wiki/Gluten-free_diet

http://www.glutenfreecookingschool.com/archives/what-to-eat-on-a-gluten-free-diet-week-one/

http://www.cdhnf.org/user-assets/documents/pdf/GlutenFreeDietGuideWeb.pdf

**********

Has anyone else gone gluten-free?  How has it worked for you and how do you deal with eating out or passing up yummies that you know are bad for you?  How 'bout I just go with watermelon and protein shakes.  Does that work?