Glutathione for Fibromyalgia

Original Post By Immune Health



Conventional treatment for fibromyalgia usually concentrates on addressing its many symptoms which may all be regarded as separate illnesses: multiple points of chronic muscle pain, stiffness, burning and tingling sensations of the skin (small fiber neuropathy), migraines, insomnia, constant fatigue, depression, anxiety, irritable bowel syndrome.


What makes it especially difficult to prescribe a successful treatment for fibromyalgia is that the exact causes are still unknown. And there are no tests to diagnose this condition with absolute certainty. Some researchers classify fibromyalgia as a type of a rheumatic disorder; some place it in the same category as the Gulf War syndrome, environmental illness and multiple chemical sensitivity generally known as idiopathic environmental intolerances (“idiopathic” means “of unknown cause”). Fibromyalgia may also be mistaken for chronic fatigue syndrome since these two conditions share many symptoms. Some doctors prescribe treatment for fibromyalgia viewing it as a hypothalamus dysfunction that affects hormonal, adrenal and sleep systems.

One thing that can be stated with certainty, having been confirmed by numerous studies, is that fibromyalgia is characterized by high levels of oxidative stress resulting in mitochondrial dysfunction. 

(Mitochondrial dysfunction and molecular pathways of disease. Pieczenik SR, Neustadt J.  Exp Mol Pathol. 2007Aug; 83(1):84-92; Could mitochondrial dysfunction be a differentiating marker between chronic fatigue syndrome and fibromyalgia?Castro-Marrero J, Cordero MD. Antioxid Redox Signal. 2013 Nov 20;19(15):1855-60).


It has been confirmed that patients with fibromyalgia have abnormal DNA fragmentation and changes in the number and size of mitochondria in their muscle tissue (Increased DNA fragmentation and ultrastructural changes in fibromyalgic muscle fibres. Sprott H, Salemi S et al. Ann Rheum Dis. 2004 Mar; 63(3):245-51).

Mitochondria are tiny engines inside all our cells that produce energy from nutrients and oxygen fueling all movement in tissues and muscles. According to Dr. Jacob Teitelbaum, a world renowned expert on fibromyalgia and chronic fatigue syndrome, if muscles do not have enough energy, they get stuck in the shortened position and cause pain as seen in fibromyalgia patients.

One recent study investigated a whole range of oxidative/antioxidant markers in 45 female fibromyalgia patients and 25 age-matched healthy controls: lipid and protein peroxidation, oxidative DNA damage, total antioxidant capacity (TAC), and antioxidant enzyme activities and compounds. The results showed that all fibromyalgia patients had a significant increase in oxidative DNA damage and protein carbonyl content (a biomarker of oxidative stress), as well as excessive levels of copper and ceruloplasmin (a biomarker of acute and chronic inflammation), and diminished levels of TAC and zinc. Zinc is an important glutathione cofactor and low levels of zinc lead to low glutathione levels and suppression of the immune system.

Zinc is also required as a component of the crucial antioxidant enzyme superoxide dismutase (SOD). Levels of SOD and two other important antioxidant enzymes, glutathione peroxidase (GPx) and catalase (CAT) were lower in fibromyalgia patients versus healthy controls. SOD neutralizes highly damaging superoxide radical, while GPx and CAT - hydrogen peroxide and hydroxyl radical. Low SOD is always observed in connection with low plasma glutathione levels. These finding demonstrate an imbalance in the oxidant-antioxidant status of fibromyalgia patients which is likely to aggravate their symptoms. (Is fibromyalgia-related oxidative stress implicated in the decline of physical and mental health status? La Rubia M, Rus A. Clin Exp Rheumatol. 2013 Nov-Dec 31(6 Suppl 79):S121-7).


Also, brain is extremely susceptible to oxidative damage, hence the possible root cause of the hypothalamus dysfunction seen as the cause of fibromyalgia. This is due to the fact that brain cells do not produce much catalase, relying mostly on glutathione peroxidase to combat hydrogen peroxide and hydroxyl radicals. This happens most effectively while we are in a deep sleep. Disturbance of deep sleep prevents these antioxidant activities from being effective creating a vicious cycle of never ending oxidative damage and worsening of the health condition.

This research indicates that the treatment for fibromyalgia should concentrate on the restoration of the redox balance and on the reversal of the acute oxidative stress damaging DNA and the energy-producing mitochondria, which may be achieved only through the glutathione optimizing therapies.

Glutathione produced in each and every cell of the body is the cornerstone of immune health and the master antioxidant that regulates all other antioxidants, restores some of them to their active state (e.g. vitamins C and E and alpha-lipoic acid), repairs DNA damage, decreases free radical and oxyradical damage inside and outside the cells, detoxifies numerous heavy metals and toxins, transfers energy from mitochondria to the cell (obviously, an impaired mechanism in fibromyalgia and other conditions characterized by severe fatigue). Glutathione is so important that its low levels serve as a signal for a cell to activate cell death mechanisms. (Glutathione efflux and cell death. Franco R, Cidlowski JA. Antioxid Redox Signal. 2012 Dec 15;17(12):1694-713 ).
More details on glutathione and its many vital functions can be found on our page Glutathione (GSH).
Although the connection of fibromyalgia to low glutathione has not yet been studied extensively, suboptimal glutathione levels have indeed been found in patients with fibromyalgia. In one study that examined 37 patients versus 37 healthy controls serum glutathione and catalase levels were significantly lower in patients with fibromyalgia than in controls. In addition, the correlation between glutathione level and morning stiffness was found to be significant. The research team came to the conclusion that these two antioxidants might have impact on the pathogenesis of fibromyalgia. (Serum antioxidants and nitric oxide levels in fibromyalgia: a controlled study. Sendur OF, Turan Y et al. Rheumatol Int. 2009 Apr; 29(6):629-33).
Chronic inflammatory state is always accompanied by low glutathione levels because it produces high amounts of free radicals that the antioxidant network and glutathione have to work extra hard to neutralize. An inflammatory state accompanied by an altered stress response, manifested by an increased release of inflammatory cytokines, high circulating levels of C-reactive protein (an inflammatory biomarker), and high levels of cortisol (the so-called “stress hormone” elevated levels of which are connected with a whole host of health concerns and a suppressed immune system), were found in 25 fibromyalgia patients in the study Inflammatory/stress feedback dysregulation in women with fibromyalgia (Bote ME, García JJ et al.) published in Neuroimmunomodulation in 2012.
It is not clear whether low glutathione levels are a cause or a result of fibromyalgia. However, in her book “Prescription for Nutritional Healing” Phyllis Balch, CNC, mentions the following possible triggers of fibromyalgia:

• chronic stress
• anxiety
• depression
• lack of sleep (especially restorative deep sleep)

• overexertion
• grief
• trauma
• infectious illness

All of them are known factors of glutathione depletion, especially if nutritional deficiencies of glutathione building blocks and cofactors are present (not at all an uncommon thing in our fast-paced lives). Additionally, none of these possible triggers exists alone, and their combined effect, aggravated by daily exposure to toxins, becomes a tipping point for glutathione levels.

RAISING GLUTATHIONE AS A TREATMENT FOR FIBROMYALGIA

Treatment for fibromyalgia aimed at raising and maintaining optimal glutathione levels may be the key to successful reversal of the fibromyalgia symptoms.

For example, in one placebo-controlled study fibromyalgia patients were treated with SAMe which is the amino acid methionine partially converted to cysteine. Cysteine is a crucial building block for glutathione. The availability of cysteine is a limiting factor in how much and how fast cells can produce glutathione. Our bodies are able to convert methionine into cysteine, SAMe being an intermediary step in this process. The resulting cysteine can be used for glutathione production. However, this process can be easily interrupted if there are nutritional deficiencies of folate and vitamin B-12 (both are glutathione cofactors), a common occurrence in fibromyalgia patients who often suffer from malnutrition. Although SAMe was used in this study primarily to address depression (most common medical use of SAMe) and the glutathione levels were not the subject of investigation, this treatment for fibromyalgia showed that the number of painful anatomic sites decreased after administration of SAMe. (Evaluation of S-adenosylmethionine in primary fibromyalgia. A double-blind crossover study. Tavoni A, Vitali C et al. Am J Med. 1987 Nov 20;83(5A):107-10). SAMe is mentioned as one of the possible ways to improve glutathione levels in the book “Glutathione (GSH). Your body’s most powerful protector” by Dr. Jimmy Gutman.

Oxidative stress decreased and all antioxidant parameters improved in the study that examined the effects of 12-week combined exercise therapy in 30 fibromyalgia patients. Pain intensity, the number of tender points and depression scores improved significantly as a result of this therapy. The conclusion was reached that "we should focus on oxidative stress in the treatment for fibromyalgia with the main objective of reducing oxidative load". (Effects of 12-week combined exercise therapy on oxidative stress in female fibromyalgia patients. Sarıfakıoğlu B, Güzelant AY et al. Rheumatol Int. 2014 Oct;34(10):1361-7). Moderate exercise is known to improve glutathione levels.
Also, treatment for fibromyalgia with the glutathione cofactors, vitamins C and E, resulted in lower lipid peroxidation levels after 12 weeks of supplementation. Plasma concentration of reduced (active) glutathione was lower in the patients than in healthy controls and it increased with supplementation. Glutathione peroxidase activity in erythrocytes was also increased. (Vitamins C and E treatment combined with exercise modulates oxidative stress markers in blood of patients with fibromyalgia: a controlled clinical pilot study. Nazıroğlu M, Akkuş S. Stress. 2010 Nov; 13(6):498-505). The pain symptoms did not improve however, because treatment for fibromyalgia with these two cofactors can improve the activity of the existing glutathione, but does not create new molecules, and thus these vitamins are not enough to optimize glutathione levels to the point that would allow the body to start and carry out the reparative process, especially when fibromyalgia has been affecting all the systems for years, in some cases decades.
What would it take to optimize and maintain glutathione levels to give the body a chance to start the healing process? There are many ways to raise glutathione: natural supplements, foods, cofactor vitamins and minerals, pharmaceutical interventions, and most importantly – the amino acid precursors, especially cysteine, and in the form that the cells can use, without which the GSH molecule cannot be formed.


Sources:
1. "Prescription for Nutritional Healing" by Phyllis Balch, CNC.
2. "Glutathione. Your body's most powerful protector" by Dr. Jimmy Gutman.
3. "Health and Nutrition Secrets" by Dr. Russell Blaylock.
4. "Glutathione. The Ultimate Antioxidant" by Dr. Alan Pressman.
5. "Alternative Cures" by Bill Gottlieb.
6. Oxidative stress in fibromyalgia: pathophysiology and clinical implications. Cordero MD. Reumatol Clin. 2011 Sep-Oct;7(5):281-3.
7. Oxidative stress, mitochondrial dysfunction and, inflammation common events in skin of patients with Fibromyalgia. Sánchez-Domínguez B, Bullón P et al. Mitochondrion. 2015 Mar;21:69-75.
8. Oxidative stress and antioxidative parameters and metal ion content in patients with fibromyalgia syndrome: implications in the pathogenesis of the disease. Fatima G, Das SK et al. Clin Exp Rheumatol. 2013 Nov-Dec;31(6 Suppl 79):S128-33.
9. The abstracts of the studies mentioned in the text.

5 Hidden But Common Causes of Estrogen Dominance Revealed

Posted on Jan. 11, 2017, 6 a.m. in Women's Health Nutrition Weight and Obesity

Listed are five causes of estrogen dominance that are frequently overlooked.

Estrogen dominance is a destructive health condition where estrogen levels are too high in relation to other reproductive hormones. Since it’s rarely acknowledged in the conventional medical community, you’ll likely need to take your health into your own hands to diagnose and overcome it. Below is a list of five causes of estrogen dominance that you need to be aware of, which are often overlooked in estrogen dominance literature.

Hidden Cause #1: Excess Body Fat

- Fat cells store large amounts of aromatase, an enzyme that creates a very potent type of estrogen called estradiol. - The more fat cells you have, the more estradiol that is created.

- High estrogen cues your body to make more fat cells.

- High estrogen levels causes an increase in the production of Sex Hormone Binding Globulin, which makes testosterone unable to do its job.

- The decrease of free testosterone reduces muscle mass, increases fatigue, and lowers stamina and energy (interfering with exercise efforts).

- These factors combined, increase body fat accumulation, cause estrogen levels to rise even further, and worsen estrogen dominance symptoms – creating a vicious cycle that is hard to break.

Hidden Cause #2: Alcohol

- There is a well-established link between alcohol consumption and high levels of estradiol, which is the type of estrogen that is most often associated with estrogen dominance and hormonal cancers.

- The association occurs because your liver is responsible for clearing toxins from the bloodstream (including alcohol and estrogen). When you drink alcohol, your liver becomes preoccupied with eliminating the alcohol toxins, which reduces its ability to clear estrogens from your system.

Hidden Cause #3: Caffeine

- Caffeine consumption stimulates the adrenal glands causing them to release stress hormones to prepare the body to fight.

- Regular consumption can exhaust your adrenal glands, and cause them to stop releasing adequate levels of essential hormones.

- Insulin is one of those hormones, and the impaired insulin causes blood sugar fluctuations, which in-turn, leads to chronic inflammation.

- Inflammation increases oxidative stress and can result in a reduction of testosterone and progesterone; both of which are required in order to keep estrogen level in-check.

Hidden Cause #4: Birth Control

- Birth control pills flood your body with synthetic estrogen, that is both foreign and unnatural.

- Your body metabolizes these synthetic estrogens into harmful versions of estrogen which increase estrogen dominance symptoms.

- Birth control pills increase the production of SHBG, which lowers testosterone levels, and makes estrogen dominance even worse.

- Birth control pills also suppress the production of natural progesterone, and progesterone is needed in order to keep estrogen levels in-check.

Hidden Cause #5: Animal Products

- Animals produce large amounts of estrogen by their very nature, and they are particularly high in estradiol which is chemically identical to the estradiol found in the human body.

- Animal products are a major contributor to estrogen dominance; and if you consume them, you are exposed to between 10,000 and 1,000,000 times more estrogen molecules than you otherwise would be.

- Conventionally raised animals are even more harmful because they’re often injected with synthetic estrogens to fatten them-up and make them grow quicker.

- The fats found naturally in animal products also increases the conversion of the healthful types of estrogen (such as estrone) into the more harmful forms of estrogen that are responsible for estrogen dominance and hormonal cancers.

~Written by Nick Delgado, PhD, CHT

Dr. Nick Delgado, PhD (www.delgadoprotocol.com) is a graduate of the University of Southern California (USC). He studied Physical Therapy at Rancho Los Amigo Hospital, Health Sciences at Loma Linda University, and Nutrition at CSLB. Dr. Delgado directed the Nathan Pritikin Plan, and is certified in NLP, Time Line, and Hypnotherapy. With an emphasis on optimal sports performance. Dr. Delgado broke the World Strength Endurance record, lifting 50,640 lbs in one hour, and led Team USA to a World Championship. He is a medical commentator in the WHN Forum.

Gluathione and Skin Disease

Original post from whatisglutathione.org

Can Glutathione Relieve the Symptoms of Skin Disease?

Many people suffer from debilitating skin disorders and diseases, many of which can be prevented by boosting antioxidant levels in the body. Increased levels of natural antioxidants, such as glutathione have been shown to prevent damage, destruction and death of vital skin cells. Skin the largest and one of the most important organs in the body. Our skin acts as a natural barrier to prevent damaging toxins, chemical agents, bacteria and viruses from entering our bodies, which can cause a variety of serious diseases and conditions. The skin is composed of an intricate cellular structure, including a strong natural defense mechanism to prevent the damaging effects of toxins. The molecules contained in skin cells help reduce damaging effects of oxidation and the invasion of free radicals.

Free radicals are molecules generated by bodily cells during the natural oxidation process. An increase in free radicals can cause significant damage to the cells that are contained in soft tissues and vital organs, leading to the onset and progression of many diseases, including skin disorders. There are several types of skin disorders, the most common of which are psoriasis and eczema. These diseases, although unsightly and irritating, are not contagious.

The Causes and Symptoms of Psoriasis

Psoriasis is a chronic skin disorder that causes skin cells to grow rapidly. The accelerated growth of new skin cells causes thick silver, white or red patches of skin. Healthy skin cells grow gradually as the skin sheds older cells. Normal skin sheds dry cells approximately every three-to-four weeks as new cells grow. Psoriasis is caused when new skin cells move rapidly to the surface of the skin within a few days rather than weeks.

Skin patches called plaques range in size and shape and may become large as they begin to form together. Psoriasis plaques generally appear on the elbows, knees, hands, scalp or lower back and buttocks. Although psoriasis is more prevalent in adults, the condition can also affect children and adolescents. Researchers have suggested that psoriasis begins due to an over-reaction of the body's immune system. Psoriasis can cause dead skin cells to build up under nail beds, leading to a separation of toenails and fingernails from their beds. Psoriasis may worsen due to climate changes, stress, infection and certain toxins or medications.

The Causes and Symptoms of Eczema

Eczema is a common skin disease that affects people of all ages. The most common type of eczema is called atopic dermatitis. Symptoms include dry, itchy rashes, usually appearing on the back of the knees, face, hands or feet. Somewhat similar in nature to psoriasis, eczema causes affected areas of skin to become thickened, dry or scaly. Affected areas usually begin with red-colored rashes that may turn brown as the condition worsens. The cause of eczema has not been scientifically determined. Researchers indicate that the disease may be related to an over-reactive response by the body's natural immune system to any form of skin irritant including household products and skin care products.

Eczema may be hereditary, especially in families with histories of asthma or severe allergies. It is thought that disruptions in the skin barrier may allow moisture to permeate new skin cells as they reproduce and develop. Severe outbreaks of eczema can cause upper respiratory infections and gastrointestinal disorders. Eczema affects people of all ages, but is most common in young children. Childhood outbreaks of the disease usually disappear by age 10. Periodic outbreaks can continue throughout adulthood.

According to medical professionals, people diagnosed with eczema also have Staphylococcus aureus bacteria on skin surfaces. Internal infections or bacteria breaching the protective skin barrier may cause this. Staph bacteria can multiple rapidly when the skin barrier is compromised or broken. Fluid can accumulate under the skin, causing pus-filled patches and blisters. There is no cure for eczema and it is not contagious.

The Role of Glutathione in the Treatment of Skin Disorders

Clinical studies have shown that boosting levels of glutathione may benefit people diagnosed with psoriasis and eczema. Glutathione helps regulate function of the immune system and actually prevents immune cells from attacking and destroying healthy cells. Immune disorders are generally caused by an abundance of T-cells in the body, whose role is to fight infections caused by bacteria, viruses and a variety of environmental toxins. When any type of disease process activates T-cells, they go into fighting mode, producing and releasing enzymes called cytokines, which play a vital role in causing tumor cell death. The undetected growth of tumor cells within the body can lead to inflammatory responses and the rapid growth of skin cells.

Chronic inflammation and an over-response of the body's immune system can severely damage and kill healthy cells, leading to the onset of multiple illnesses, as well as chronic skin conditions. As our body's most powerful and natural antioxidant, glutathione helps protect the body from diseases caused by toxins, bacteria and viruses. Low levels of glutathione are linked to the development and progression of chronic illnesses including heart conditions, cancer, eye disorders, mental illness and skin disease.

Glutathione has also been shown to boost the immune system, providing optimal protection from infection and disease. Although glutathione is prevalent in leafy green vegetables, fish and certain types of fruit, the digestive process damages many of the antioxidant properties. In skin diseases, the immune system responds to pathogens and allergens affecting cells that form the protective skin barrier. Research studies have determined that skin diseases including psoriasis and eczema are caused by cellular oxidation, which can be reduced by increasing levels of glutathione. The antioxidant effects protect most vital bodily organs, soft tissues, bones and the skin from disease caused by cellular damage.

Glutathione, known as the "master antioxidant" helps boost cellular function by providing the body with the essential proteins cysteine, glycine and glutamate acid. These proteins reduce oxidative stress, assuring maximum cellular health during the growth and development process. According to researchers, increased oxidative stress in skin cells can lead to the development of skin diseases including psoriasis, eczema and some forms of skin cancer. Scientists concluded that boosting levels of glutathione would prevent oxidant injury to cells.

If you are suffering from any type of skin disease, you may wish to discuss the use of glutathione with your dermatologist or healthcare provider. The use of glutathione supplements may prevent skin disorder outbreaks and may help control your symptoms. Before beginning a regiment of glutathione or any other combinations of antioxidants, your physician may ask about your medical history and current medication use in order to determine the safety and efficacy of this treatment.

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Reference Links

http://www.webmd.com/skin-problems-and-treatment
http://www.mayoclnic.org/diseases-conditions/psoriasis
http://www.mayoclinic.org/diseases-conditions/eczema
http://glutathionepro.com/psoriasis-glutathione/
http://www.native.com/jid/journal/v126/n12/full/570

Original article from Smart Publications

Glutathione Benefits Everyone, Including People with Celiac Disease

Everyone can benefit from antioxidant supplements, but a new study shows that it is especially important for people with celiac disease. Celiac is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. It is caused by intolerance to gluten, which is found in wheat, rye, barley and oats.

According to findings published in the September 2009 issue of the journal Clinical Biochemistry, individuals with celiac disease have a major reduction in their antioxidant levels due to a reduction in levels of the antioxidant glutathione.

The study looked at 39 children with different forms of celiac disease and 19 celiac-free children. Intestinal biopsies showed an increase in the activities of antioxidant enzymes such as superoxide dismutase in children with active and silent celiac disease. The elevated activities of these enzymes are in response to the higher levels of reactive oxygen molecules, which cause free radical damage.

The level of lipid hydroperoxides (LPOs) was 80 to 100% higher in the children with celiac disease than in the control group. Lipid peroxides are the by-products of the chemical damage done to the lipid or fat components of cell membranes by free radicals. This oxidative damage is believed to be a basic mechanism underlying many diseases, chronic health problems and aging. An increase in oxidative stress is an important factor in the progression of celiac disease.

Additionally, the activities of glutathione peroxidase and glutathione reductase and the glutathione content were significantly reduced.

The scientists concluded that the antioxidant capacity of celiac patients is significantly reduced, mostly by a depletion of glutathione. Natural antioxidants and appropriate dietary supplements could be important complements to the classic therapy of celiac disease.1

Glutathione is vital to everyone’s health, not just Celiacs

Glutathione is the major antioxidant produced by almost every cell in your body, protecting it from free radicals. Glutathione plays many roles, including these:

• Recycles vitamin C and vitamin E, keeping them in their active state
• Enables the body to get rid of toxins and pollutants
• Helps maintain a normal balance between oxidation and anti-oxidation, which regulates many of the cell’s vital functions, such as the synthesis and repair of DNA, the synthesis of proteins and the activation and regulation of enzymes
• Carries out an immune response by helping lymphocytes and killer T-cells multiply and kill cancer cells and virally infected cells
• Supports healthy mitochondrial function

How to increase your glutathione levels

Glutathione is available as a dietary supplement , and that may be your best bet.  You can also take other dietary supplements that are a precursor to glutathione.

N-Acetyl-Cysteine, also referred to as NAC, is a stable and bioavailable form of cysteine, which is a potent glutathione precursor. Acetylcysteine converts to cysteine within the cell, acting as a precursor to glutathione and contributing to its regeneration. In addition to raising the body’s antioxidant levels, NAC supports healthy aging, and is beneficial for preventing heart disease, memory loss and cancer.

Emblica (Emblica officinalis), also known as Amla, is an herbal antioxidant and has one of the highest contents of vitamin C of any natural plant. Studies show that it has the ability to stimulate our natural antioxidant enzyme systems including catalase, superoxide dismutase (SOD) and glutathione peroxidase.

Schisandra (Schisandra chinensis) is best known as an adaptogen to improve the body’s ability to respond to stress, recover from exhaustion and fight disease. Schisandra also increases glutathione levels. Be sure to look for a Schisandra product that is standardized to contain schisandrins, the active ingredients found in schisandra fruit.

Celiac disease

Celiac disease is both a disease of malabsorption—meaning nutrients are not absorbed properly—and an abnormal immune reaction to gluten, a protein found in wheat, rye, barley and oats. Celiac disease is genetic, and is also known as celiac sprue, nontropical sprue and gluten-sensitive enteropathy. Sometimes the disease is triggered after surgery, pregnancy, childbirth, viral infection or severe emotional stress.

Symptoms of celiac disease vary from person to person. Symptoms may occur in the digestive system or in other parts of the body. Digestive symptoms are more common in infants and young children and may include

• Abdominal bloating and pain
• Chronic diarrhea
• Vomiting
• Constipation
• Pale, foul-smelling, or fatty stool
• Weight loss

Irritability is another common symptom in children. Malabsorption of nutrients during the years when nutrition is critical to a child’s normal growth and development can result in other problems such as failure to thrive in infants, delayed growth and short stature, delayed puberty, and dental enamel defects of the permanent teeth.

Adults are less likely to have digestive symptoms and may instead have one or more of the following:

• Unexplained iron-deficiency anemia
• Fatigue
• Bone or joint pain
• Arthritis
• Bone loss or osteoporosis
• Depression or anxiety
• Tingling numbness in the hands and feet
• Seizures
• Missed menstrual periods
• Infertility or recurrent miscarriage
• Canker sores inside the mouth
• An itchy skin rash called dermatitis herpetiformis

People with celiac disease may have no symptoms but can still develop complications of the disease over time. Long-term complications include malnutrition—which can lead to anemia, osteoporosis, and miscarriage, among other problems—liver diseases, and cancers of the intestine. 2

JUVÉDERM

JUVÉDERM is a colorless injectable gel of hyaluronic acid. Hyaluronic acid is a natural substance that holds 1,000 times it's weight in water. JUVÉDERM injectable gel is used for deep injection for cheek filling or augmentation, lip plumping and shaping and to correct age-related volume loss in the mid-face areas.

JUVÉDERMVoluma XC

Adds volume that looks natural. Can last last up to 2 years with each application!

Is there anyone that cannot be treated?

JUVÉDERM should not be used for those who have allergies marked by history of anaphylaxis, a history or presence of multiple severe allergies, or patients with a history of allergies to gram-positive bacterial proteins. Juvederm should be used with caution for those on immunosuppressive therapy, as there may be an increased risk of infection. The safety of Juvederm has not been established in breastfeeding females, during pregnancy, or in patients under the age of 18.

What should I expect with my JUVÉDERM treatment?

Some adverse reactions include increased bruising or bleeding at the injection site if you are taking aspirin or ibuprofen before your treatment.

What are post treatment procedures?

For the first 24 hours following treatment, you should avoid strenuous exercise, excessive sun or heat, and consumption of alcoholic beverages. This minimizes the risk of temporary redness, swelling, and/or itching at the treatment sites. These temporary side effects generally resolve themselves within one week. An ice pack can be applied to the site if you experience swelling, do not apply pressure when using ice-packs. You may apply makeup as usual.