Ask the Doctors: Anti-inflammatory supplements can help psoriasis

Hello, dear readers, and welcome back to the monthly letters column. We continue to get questions about the coronavirus vaccine and virus variants, and we'll address them in a separate column soon. This time, though, we'll focus on nonvirus questions and concerns.

— In response to a column about psoriasis, a reader asked about natural remedies. "I have severe psoriasis but am terrified to take a biologic," she wrote. "Is there a safe anti-inflammatory herbal product that could help?" Biologic drugs use biotechnology to act on a wide range of cellular processes. They can be quite effective, but some people aren't comfortable using them. Since psoriasis is a skin disorder rooted in inflammation, anti-inflammatory supplements may be useful in some cases. Turmeric, a flowering plant used as a cooking spice, contains a powerful anti-inflammatory called curcumin. It, along with ginger and omega-3 fatty acids, have the best data as natural approaches to psoriasis management. Aloe extract cream and barberry, also known as Oregon grape, both have anti-inflammatory properties and may be helpful. Before you add supplements to your treatment regimen, check with your health care provider. They can help you decide which ones to try, and how to use them.

— After reading a column about a regular blood donor who was turned away due to chronic anemia, a fellow blood donor shared her own experience. "Some years ago, when I began taking calcium for osteoporosis, I began being deferred for donations," she wrote. "When a blood bank technician learned that I took my iron and calcium supplements at the same time, she told me that calcium blocks the absorption of iron. Since I stopped taking my iron with calcium, I haven't been deferred." It's correct that calcium can interfere with iron absorption. We recommend taking iron supplements with vitamin C, which enhances absorption, and calcium supplements separately. But as we said in the column, when an older adult develops chronic iron deficiency anemia, it's imperative that they be evaluated for occult bleeding.

— In a discussion about managing medications for older adults, we talked about the use of weekly pill organizers. A reader pointed out that this isn't an answer for everyone. "These types of pill organizers, especially the ones that store three weeks' worth of pills, can be dangerous for some elderly people," they wrote. "They can get confused about what day of the week it is, and run the risk of taking the same day's pills twice." It's true that for people with cognitive issues, taking medications can be a challenge. A possible solution is an automatic pill dispenser. This is a portable locked device that is programmed to dispense one round of medications at a time. Most include a visual and audio alert as well. These are somewhat costly, in the range of $80 to $100, and, unfortunately, are not automatically covered by Medicare.

Thank you, as always, for taking the time to write to us. We enjoy knowing where you're writing from, and we never use your names in our columns.

Dear Doctor: Can you explain that study that says having too much sugar in your diet is going to make your body produce more fat? I always thought that the reason you gained weight was that you were eating too many calories.

Dear Reader: We believe you're referring to a study published in the Journal of Hepatology in March. (Hepatology is the study of the liver, gallbladder and pancreas.) Because it focused on the ever-fascinating topic of the health effects of added sugar in the diet, the results received a fair bit of media attention.

You mentioned calories and weight gain, but that wasn't the specific focus of this study. Rather, researchers in Zurich wanted to learn how sugar consumption affects the accumulation of fat in the liver. This may sound obscure, but due to a potentially serious condition known as fatty liver disease, it's an important area of inquiry.

A healthy liver contains fat in small amounts. When fat begins to build up, though, it can cause inflammation. This, in turn, can lead to liver damage. One form of this condition, known as alcoholic fatty liver disease, is associated with heavy drinking. When fat accumulates in the livers of people who don't drink heavily, it's known as nonalcoholic fatty liver disease. It's estimated that 25 percent of people in the United States, including children, have some degree of nonalcoholic fatty liver disease. For most, the condition doesn't cause noticeable problems. But for up to one-third of them, the condition can progress and affect liver function.

Risk factors for nonalcoholic fatty liver disease include obesity, particularly when high levels of belly fat are present; insulin resistance; diabetes; elevated blood pressure; sleep apnea; and high blood lipid levels. And now, this new study suggests that certain types of added sugars can also play a role.

The researchers had 94 healthy men add a beverage sweetened with 80 grams of one of three different types of sugar to their regular diet. That's the equivalent of two cans of soda. Using radioactive tracers, they monitored the effect on levels of liver fat during the seven weeks of the study. No changes to fat accumulation were seen in the men drinking glucose, which is the simple sugar our bodies produce and use for energy. But the group whose drinks were sweetened with sucrose or with a liquid form of fructose had double the fat accumulation of the glucose group. This effect continued for 12 hours after their last sweetened drink. The takeaway is that the added sugars we find in so many of our foods may be adversely affecting us, often in ways we can't see or feel, and causing harm.

The American Heart Association recommends that women and men limit sugar intake to 25 and 48 grams per day, respectively. That's about 6 teaspoons for women and about 9 for men. Sugar is so easily and widely available, it can be hard to avoid. But emerging research continues to show that, for your longterm health and well-being, it's an important step to take.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.