K Ljunghall’s research while affiliated with Uppsala University Hospital and other places

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Publications (13)


Changes in Lipoprotein Metabolism during a Supplemented Fast and an Ensuing Vegetarian Diet Period
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  • Full-text available

February 1985

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32 Reads

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1 Citation

Upsala Journal of Medical Sciences

H Lithell

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A Bruce

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I B Gustafsson

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[...]

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The effect on lipoprotein metabolism of a 2-week modified fast and an immediately ensuing 3-week period on a vegetarian diet was studied under metabolic ward conditions in 21 non-obese female and 6 male patients. The very low calorie diet induced reductions of the cholesterol concentration in all serum lipoprotein classes. In the female patients, who were all normolipoproteinaemic, the triglycerides in serum showed a slight increase during the fast, reflecting small changes in very low (VLDL) and low density lipoprotein triglycerides. This may probably be explained partly by simultaneous significant reductions of both the adipose tissue and skeletal muscle tissue lipoprotein lipase activities (LPLA). In contrast, in the male patients who had a higher VLDL level at admission, the VLDL triglycerides decreased without significant changes of high density lipoprotein (HDL) cholesterol and of LPLA in muscle. The female patients, whose weights were stable during the vegetarian diet, ended up with a lower HDL cholesterol than at the start of the trial. This effect was probably partly due to the high content of polyunsaturated fatty acids in the vegetarian diet. It is concluded that the changes of lipoprotein metabolism during supplemented fasting are quantitatively and qualitatively different in several respects in females and males.

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Gluten-Free Diet in Patients With Dermatitis Herpetiformis: Effect on the Occurrence of Antibodies to Reticulin and Gluten

January 1984

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6 Reads

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11 Citations

Archives of Dermatology

• In a prospective study of 51 patients with dermatitis herpetiformis (DH), the occurrence of antibodies against reticulin and gluten was investigated and the influences of gluten-free, gluten-restricted, and normal diets on the persistence of these antibodies were compared. After a period extending from 11 to 47 months, none of the patients who were eating a gluten-free diet had reticulin or gluten antibodies. The patients eating a normal diet had the same incidence of reticulin autoantibodies at the end of the study as at its beginning, and gluten antibodies developed in some additional patients during the follow-up period. Thus, we have shown that the elimination of gluten from the diet of patients with DH has an important influence on the occurrence of antibodies to both reticulin and gluten. (Arch Dermatol 1983;119:970-974)


Dermatitis herpetiformis: Effect of gluten-restricted and gluten-free diet on dapsone requirement and on IgA and C3 deposits in uninvolved skin

March 1983

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9 Reads

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32 Citations

Acta Dermato-Venereologica

Of 58 patients with classical dermatitis herpetiformis (DH), 17 were treated with a gluten-free diet (GFD) for periods varying from 6 to 47 months and 11 with a gluten-reduced diet (GRD) for 7 to 29 months. The patients were able to reduce their requirement of dapsone significantly compared with 30 patients on a normal diet, of whom only an 86-year-old man was able to discontinue his 10 mg dapsone dose. In 7 of the 17 patients on GFD, dapsone could be completely withdrawn after diet periods of 4 to 38 months. None of the patients on GRD could stop dapsone treatment. The occurrence and amount of immunoglobulin A (IgA) and of the third component of complement (C3) in non-lesional skin were studied in the three diet groups during treatment. At the start of the study all patients had IgA deposits of the granular pattern. This pattern remained unchanged during the follow-up period. The amount of IgA in the skin did not decrease more in the patients on GFD than in those on an unrestricted diet. The occurrence of C3 diminished in all patient groups, but the decrease was most pronounced in the group on GFD, where C3 disappeared completely. Deposits of IgA and C3 were not uniform throughout the skin. Slightly more IgA was found in skin from the buttocks than from the forearms. Patients taking a higher dose of dapsone had less frequent C3 deposits in the skin than those taking a lower dose, which might indicate a suppressive effect of dapsone on C3 deposition.


Linear IgA dermatosis: A study of ten adult patients

March 1983

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17 Reads

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83 Citations

Acta Dermato-Venereologica

Ten adult patients with homogeneous-linear deposition of IgA along the basement membrane zone have been studied. The direct immunofluorescence IgA pattern was stable, and there was no deposition of IgG or IgM. The clinical presentations were heterogeneous and resembled dermatitis herpetiformis (DH) (3 cases) or bullous pemphigoid (5 cases). Two patients had widespread gyrate blistering lesions of acute onset. Pruritus was constantly present. The course of the disease was chronic except for one patient who had a spontaneous remission after 5 years. The histology was indistinguishable from "classical" DH with granular IgA in dermal papillae. The patients studied in the present investigation did not show the high incidence of atrophic intestinal villi found in "classical" DH. Five of 9 cases carried the haplotype HLA-A1, B8, DR3. In spite of a close similarity between linear IgA dermatosis and DH, differences exist which indicate discrepancies in etiopathogenesis.


Dermatitis herpetiformis: Relation between circulating antibodies against reticulin and gluten, small-intestinal mucosal status and absorptive capacity

February 1983

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10 Reads

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18 Citations

Acta Dermato-Venereologica

The status of the jejunal mucosa and of the intestinal absorptive capacity were investigated and related to the occurrence of antibodies against reticulin and gluten in 55 patients with dermatitis herpetiformis (DH), 28 on a normal, 11 on a gluten-reduced and 16 on a gluten-free diet. The mucosal status was characterized on the basis of histopathological findings and the numbers of intra-epithelial lymphocytes. Absorption was evaluated by 5-h urine and 1-h serum D-xylose tests. There was a positive correlation between the degree of pathological mucosal changes, malabsorption and the occurrence of circulating antibodies against reticulin and gluten. The serum xylose test was more sensitive than the urine xylose test for screening of the relatively mild enteropathy of DH and identified 88% of the patients with an abnormal mucosal status. The serological test (antibodies to reticulin and gluten) identified 80% of such patients. Among patients on a gluten-free diet there was some discrepancy between the serum xylose and the serological test, in that 5 of the 16 patients on this diet had an abnormal serum xylose test result, but no antibodies. In DH patients on a normal diet, the presence of antibodies to reticulin and gluten provided the same information about the presence of mucosal lesions as the serum xylose test. In the whole material a combination of the serum xylose test and the serological test identified 24 of 25 patients with an abnormal mucosal status.


A fasting and vegetarian diet treatment trial on chronic inflammatory disorders

February 1983

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175 Reads

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89 Citations

Acta Dermato-Venereologica

Twenty patients with arthritis and various skin diseases were studied on a metabolic ward during a 2-week period of modified fast followed by a 3-week period of vegetarian diet. During fasting, arthralgia was less intense in many subjects. In some types of skin diseases (pustulosis palmaris et plantaris and atopic eczema) an improvement could be demonstrated during the fast. During the vegan diet, both signs and symptoms returned in most patients, with the exception of some patients with psoriasis who experienced an improvement. The concentrations of lactoferrin in serum reflect the turnover and activity of neutrophil leukocytes. When this protein was initially increased it fell to normal values in most cases. The improvement or impairment of signs and symptoms was related to the lactoferrin levels in serum.


Changes in Metabolism during a Fasting Period and a Subsequent Vegetarian Diet with Particular Reference to Glucose Metabolism

February 1983

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42 Reads

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5 Citations

Upsala Journal of Medical Sciences

During an investigation on the effect of fasting and a vegetarian diet on the symptoms and signs in chronic cutaneous and arthritic diseases studies were made of glucose metabolism, liver function and the plasma concentration and urine excretion of some minerals. The study was performed on 27 patients who stayed as in-patients on a metabolic ward for five weeks. After the fasting period the blood glucose and serum insulin concentrations were lower (p less than 0.01) than before the fast. At the end of the period on the vegetarian (vegan) diet (three weeks) the insulin/glucose ratio was lower than at the start of the fast. Serum enzyme concentrations reflecting liver function increased during the fast, but normalized during the vegan diet. The intake of vitamin B12 and of selenium due to the vegan diets was very low, which may give reason for some concern during long-term use of this type of vegetarian diet.


Blood Glutathione Peroxidase Levels in Skin Diseases: Effect of Selenium and Vitamin E Treatment

February 1982

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104 Reads

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62 Citations

Acta Dermato-Venereologica

Blood glutathione-peroxidase (GSH-Px) was determined in 61 healthy subjects and 506 patients with various skin disorders. Depressed levels were observed in patients with psoriasis, eczema, atopic dermatitis, vasculitis, mycosis fungoides and dermatitis herpetiformis. Low values of GSH-Px were also found in some patients with pemphigoid, acne conglobata, polymyositis, rheumatoid arthritis, scleroderma and systemic lupus erythematodes. Vegetarian diet, malnutrition and alcohol abuse could possibly account for the low values in some patients. Fifty patients with low GSH-Px levels were treated with tablets containing 0.2 mg selenium as Na2SeO3 and 10 mg tocopheryl succinate. The GSH-Px levels increased slowly within 6-8 weeks of treatment. The clinical effect was encouraging and calls for controlled studies.


T lymphocyte subsets in the duodenal epithelium in dermatitis herpetiformis

February 1982

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7 Reads

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6 Citations

Acta Dermato-Venereologica

Monoclonal antibodies to human T lymphocyte subsets and HLA-DR antigens were used to characterize the intra-epithelial T lymphocytes and HLA-DR reactive cells in the duodenal epithelium in dermatitis herpetiformis (DH). The expression of HLA-DR antigens on the epithelial cells was similar in patients and controls. There were significantly more Leu 2a (suppressor/ cytotoxic phenotype) reactive cells, as related to epithelial length, in 7 patients with DH than in the epithelium of 5 controls. However, the ratio of Leu 2a (suppressor/cytotoxic phenotype) to Leu 3a (helper/inducer phenotype) reactive cells was the same in the patients as in the controls. Thus this study indicates that there is a quantitative rather than a qualitative difference in T lymphocyte subpopulations in duodenal epithelium between patients with DH and normal persons.


Citations (11)


... Even patients who fail to eliminate but only reduce their gluten intake may gain some benefit, however without complete control of the cutaneous condition, depending on the medication. 20,21 In addition to resolving cutaneous and gastrointestinal symptoms, a gluten-free diet improves malabsorption, allowing dose reduction and possibly discontinuation of medication and helping prevent the development of lymphomas by lowering persistent antigenic stimulation. ...

Reference:

Consensus on the treatment of autoimmune bullous dermatoses: dermatitis herpetiformis and linear IgA bullous dermatosis - Brazilian Society of Dermatology
Dermatitis herpetiformis: Effect of gluten-restricted and gluten-free diet on dapsone requirement and on IgA and C3 deposits in uninvolved skin
  • Citing Article
  • March 1983

Acta Dermato-Venereologica

... Genetic factors may also contribute to the development of LABD and CBDC. Associations of LABD with HLA-B8 have been reported in several studies [89][90][91], whereas others have found no significant association [92,93]. Wojnarowska et al. reported an increased frequency of HLA-B8 in CBDC and LABD in the UK, with a significantly higher incidence in CBDC (76%) compared to LABD (28%) [94]. ...

Linear IgA dermatosis: A study of ten adult patients
  • Citing Article
  • March 1983

Acta Dermato-Venereologica

... Moreover, patients with DH and GSE share a number ofother features, such asjejunal atrophy correctable by elimination of gliadin from the diet, i Abbreviations used in this paper: DH, dermatitis herpetiformis; GSE, gluten-sensitive enteropathy. 2067 and the presence of anti-a-gliadin (17,18) and antireticulin (19,20) Previous studies of DH have almost exclusively reported HLA phenotypes in patients rather than haplotypes determined in family studies . Haplotype comparisons, including analysis for complotypes and other MHC genes, are critical to localizing candidate susceptibility genes, and we undertook such studies in patients with DH. ...

Circulating reticulin autoantibodies of IgA class in dermatitis herpetiformis
  • Citing Article
  • March 1979

British Journal of Dermatology

... Previous studies suggest a possible connection between LPL activity and nutrition [6][7][8][9]. Firstly, changes in diet can affect LPL activity through alternations in plasma concentrations active LPL on the endothelium and (b) the total effect of various extracellular regulators on LPL activity. ...

Changes in Lipoprotein Metabolism during a Supplemented Fast and an Ensuing Vegetarian Diet Period

Upsala Journal of Medical Sciences

... In 29 acne vulgaris patients, supplementation with 0.2 mg Se (and 10 mg tocopheryl succinate) for 6-8 weeks slowly increased Se-GPx levels [164]. In contrast, if the low levels of Se glutathione-peroxidase in blood from patients with dermatitis herpetiformis increased after five months of Se treatment, no significant clinical improvement was observed [165]. Fairris et al. [166] showed that a daily 600 µg of Se-enriched yeast intake for 12 weeks increased plasma Se concentrations and platelet GPx activity of psoriasis patients, but not in their skin. ...

Selenium glutathione-peroxidase and dermatitis herpetiformis
  • Citing Article
  • February 1984

Acta Dermato-Venereologica

... Selenium protects the skin from UV radiation induced oxidative stress [37] . Selenium used in treatment of psoriasis which shows decreased glutathione peroxides levels [38] . By comparing the data obtained from XRF, ICP-OES, XRD and EDX, it is found that the content of carbon, phosphorus, sulfur, potassium, iron, copper and strontium in FBGLA>FBYLA, The content of oxygen, zinc, sodium, aluminum, silicon, calcium, boron, and palladium in FBGLA<FBYLA, the content of magnesium in FBGLA>FBYLA according to ICP-OES, the content of magnesium in FBGLA was found to be lesser as measured by EDX. ...

Blood Glutathione Peroxidase Levels in Skin Diseases: Effect of Selenium and Vitamin E Treatment
  • Citing Article
  • February 1982

Acta Dermato-Venereologica

... Moreover, patients with DH and GSE share a number ofother features, such asjejunal atrophy correctable by elimination of gliadin from the diet, i Abbreviations used in this paper: DH, dermatitis herpetiformis; GSE, gluten-sensitive enteropathy. 2067 and the presence of anti-a-gliadin (17,18) and antireticulin (19,20) Previous studies of DH have almost exclusively reported HLA phenotypes in patients rather than haplotypes determined in family studies . Haplotype comparisons, including analysis for complotypes and other MHC genes, are critical to localizing candidate susceptibility genes, and we undertook such studies in patients with DH. ...

Dermatitis herpetiformis: Relation between circulating antibodies against reticulin and gluten, small-intestinal mucosal status and absorptive capacity
  • Citing Article
  • February 1983

Acta Dermato-Venereologica

... Genetic, immune, and environmental factors (including diet) are considered to be essentially associated with the pathogenesis of psoriasis (12) . Furthermore, fasting as well as low energy and vegetarian diet can improve its symptoms (13)(14) . Diets rich in n-3 polyunsaturated fatty acids such as in sh oil have also shown bene cial effects (15) . ...

A fasting and vegetarian diet treatment trial on chronic inflammatory disorders
  • Citing Article
  • February 1983

Acta Dermato-Venereologica

... Two of the patients (one fcmale and one male) deteriorated clinically during the fast and discontinued the trea1ment. The patients suffered from the following diseases: psoriasis wilh arthritis (10 patients), pustulosis palmaris et plantaris (4), atopic cxzema (3), rosacea (3). No patient experienced an acute exacerbation of the disease at the time for the s1udy. ...

Changes in Metabolism during a Fasting Period and a Subsequent Vegetarian Diet with Particular Reference to Glucose Metabolism

Upsala Journal of Medical Sciences