Dr. Anders Nerman, N.D. Naturopathic Doctor in Israel
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Eczema on the Rise in Israel: Can Naturopathic Medicine Help?

5/22/2014

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A week does not go by when someone does not bring his or her child into my Jerusalem based office for treatment of Eczema (also termed Atopic Dermatitis). This skin condition is located primarily on the face, back of the knees, wrists, hands, or feet. It is almost always itchy. It is often red and inflamed and can become infected. It may be hard to believe but sometimes its is so severe people seek emergency medical treatment in hospitals. I have had a few patients who were hospitalized at Hadassah for this condition.  

Eczema is on the rise in all first world countries.  The prevalence of eczema has doubled or tripled in industrialized countries during the past three decades.
 In Israel, atopic eczema was found to be increasing [from 5.9% (1997) to 8.7% (2003). No one knows precisely what causes eczema or why it is becoming more prevalent in western societies. While first world countries decreased steadily in the number of cases of infectious disease, there has been a yearly increase in cases of allergic (atopic) diseases.  

Research has shown eczema to have a clear genetic component, as a child with parents having either eczema, asthma or hay fever will be far more likely to develop eczema or one of these other atopic/allergic conditions.

I am writing this article to give my perspective on what alternative medicine has to offer children and adults with eczema. Although what causes eczema is not known, much research has been done looking at alternative treatments and their effectiveness. Some of these studies shed light on what is going on in the body with people who have eczema. My hope in this article is to expose you to some real evidenced based treatment options and give some new insights about the disease.

Western Treatment Options:

Before we begin with alternative medicine, lets consider the options our western medical doctors offer.  In truth, treatment options are limited, with some having unwanted side effects. The two main options are emollient therapy - moisturizers – and topical steroid creams, which suppress the skin's immune response. Topical steroids are a common first line of defence and may be necessary to deal with the severe symptoms of eczema. However, Naturopathic Medicine strives to treat the cause of the disease, not only the symptoms. 

The Triggers:

Anxiety and stress, arid climates, irritants, allergens and infections are all known triggers of eczema. Food allergies and early food introduction are big culprits. 35-40% of children with eczema have food allergies. Eggs are the most common allergen along with milk, peanuts, soy, wheat, fish, shellfish, tree nuts and citrus fruits – all accounting for 90% of food allergies in eczematous children.

Does It Ever Go Away?

The good news is that approximately 50% of children will no longer be troubled by eczema by the age of 2 and 80% cent by the age of 5. The bad news is there is no cure for eczema except to reduce occurrences and control the disease.

Prevention

Babies are born to be breastfeed. Breast milk contains over 100 hundred substances not found in formula but are vital to normal development and function of your child’s immune system. Breast milk contains gamma-linoleic acid that is particularly important for babies with a family history of eczema. Recent trials have found that breast fed babies have reduced or delayed incidence of atopic diseases such as eczema, allergies and asthma and conclude that eczema tends to occur more in bottle-fed babies.

Things To Consider

Interestingly research has shown that children with poor hygiene are at a lower risk for developing eczema, as are children who drink unpasteurized milk.  These findings align with a theory called the ‘Hygiene Hypothesis’, which postulates that a lack of early childhood exposure to infectious agents, bacteria and parasites increases susceptibility to allergic diseases by suppressing the natural development of the immune system. Our overly clean environments in the industrialized world may be backfiring on us. This theory has yet to be conclusively shown to be the cause of eczema, but it is definately something to consider.

Naturopathic Understanding of Eczema:

It is believed in the alternative medical world that inherited eczema may be related to a disturbance how the body deals with essential fatty acids. It has been suggested that people with eczema have a problem with the enzyme called delta-6-desaturase, which is critical to the conversion of omega-6 fatty acids to various other important fatty acids. For people with a genetic disposition to this problem, over-consumption of refined processed foods and saturated fats can become a major trigger.  Also food allergy is believed to play a major role in eczema. Many studies have pointed specifically to cows milk and eggs as a major trigger. One study I saw showed 80% improvement in children after being off these foods for 4 weeks.

Naturopathic Treatments For Eczema:

Food Allergy: Addressing food allergies and using elimination diets and then food challenges to find the trigger foods is critically important for dealing with eczema. This however, should only be done with the supervision of a nutritionist, naturopathic or dietician. This is especially important in children, who need proper minerals and vitamins from foods to grow. For instance, when we take children off dairy and eggs without knowing what else to feed them we can compromise their development. As well, some children with very bad cases of eczema have been found to become even more allergic to a food when it is removed from the diet and then reintroduced, and there have been a few cases of severe life threatening allergic reactions. For this reason, this approach may not be safe in all cases. It is important then to find a qualified health practitioner to supervise and guide you through these dietary changes. 



Often people with Eczema come to see me after they find that the tests  with their allergist did find any IgE food allergy. In Jerusalem, I am one of the few practitioners that provides IgG Food intolerance testing. I have found time and again that this test is effective for finding the food that is triggering a patients eczema. 

Fatty Acids: As mentioned above, biochemical evaluations of patients with eczema have demonstrated abnormalities of fatty acid metabolism.  Supplementation with oils such as evening primrose oil, sunflower oil, flaxseed oil, borage oil, fish oil and hempseed oil has all shown to have very positive effects on reducing symptoms of eczema. Each has different amounts of the essential fatty acids so you may need to do some experimenting till you find the right one. I often use flaxseed oil with my patients and have seen good results.

Nickel Sensitivity: Contact with Nickel is a known cause of eczema. An allergist can test for this sensitivity.  What is less known is that even ingestion of foods high in nickel or nickel that has leached into food from stainless steel cookware can trigger eczema in people sensitive to nickel.

Environment: Improving your environment by removing dust mites from the home, washing linens weekly in hot water, avoiding carpeted bedrooms and adding a humidifier to combat dry air can all help reduce eczema symptoms and lower the incidence of relapses.

Herbal Medicine: There are many herbs that are used to support the immune system and reduce inflammation. These include Chamomile and Echinacea. Chickweed is an excellent cooling remedy for hot inflammatory skin conditions. Eczema associated with stress or anxiety can benefit from herbs that support the nervous system such as lemon balm, chamomile or vervain. Local herbal applications can be very soothing and can help resolve inflammation and infection. Licorice gel in a recent double blind trial was found to be beneficial & “Kamillosan” containing chamomile was found to be slightly superior to 0.5% hydrocortisone. Ask your local herbalist about these products to see whether they are right for your case of eczema.

Baths: Soaking in baths for 15-20 minutes daily helps to retain moisture. But it is important to dry off completely and immediately coat the skin with a naturally based emollient cream or ointment. Because eczema predisposes your child’s skin to weakness, it is less able to retain water and can cause shrinking and cracking of the skin. I often recommend an oatmeal bath because it really soothe the skin well when there is extreme itching.  Premade oatmeal bath packets are available for purchase. For weeping or infected eczema, naturopathic treatments are available and it is best to consult your doctor to ensure the infection can be well managed.

Eczema is on the rise and there is very little that western medicine can do to treat the cause. I hope that this article has shown that alternative medicine has much to offer in this regard, much of which has research behind it to show its effectiveness. It may well be time to consider the natural alternative!

Dr. Anders Nerman, ND.

Dr. Anders Nerman, N.D. is a Naturopathic Doctor with an Integrative Family Medical practice in Wolfson Medical Center in Jerusalem, Israel. For more visit www.drnerman.com or call 972-54-427-8667.

Information is provided for informational purposes only and is not intended as a substitute for the advice provided by your physician or other healthcare professional. Always speak with your physician or other healthcare professional before taking any medication or nutritional, herbal or homeopathic supplement, or adopting any treatment for a health problem.




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Dr. Anders Nerman’s Vitamin and Supplements Guide Part 2:

5/13/2014

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I my last blog (Vitamin and Supplements Guide Part 1), I discussed the common vitamin deficiencies prevalent in our society today.  In this article (Part 2), I will be discussing some other important supplements to consider taking for general health and will be identifying some supplements that are a fad and do not work. I will also be giving information on targeted supplementation for specific disorders. Let us begin!

Important Supplements to Consider
Fish Oil:

Fish oil is a very popular supplement and for good reason. Fish oil is high in omega-3 fatty acids. Hundreds of studies suggest that omega-3s may provide some benefits to a wide range of diseases: cancer, asthma, depression, cardiovascular disease, ADHD, and autoimmune diseases, such as rheumatoid arthritis.

What is it that makes omega 3 so special? Omega-3's reduce the inflammatory process that leads to many if not all of these chronic conditions.  The issue is compounded by omega 6 fatty acids, which we all are getting more than enough of in our diets today. Diets low in fresh veggies and fish are usually high in omega-6s; diets high in crackers, cookies, and corn-fed beef.  We consume at least 20 times more omega-6s than omega-3s. Optimally we are supposed to get closer to only 2 times more omega 6 than omega 3. Therefore an essential supplement to consider is fish oil. Note that there are certain conditions in which fish oil is not a good idea. High doses of fish oil might keep blood from clotting and can increase the chance of bleeding so if you are on blood thinners or have a clotting disorder, ask your doctor if it is safe to take fish oils. This is also the case if you have liver disease, or have bipolar disorder.

Coenzyme Q10:

Coenzyme Q10 (CoQ10) is a substance similar to a vitamin. It is found in every cell of the body. Your body makes CoQ10, and your cells use it to produce energy from food. Your body needs it for cell growth and maintenance. It also functions as a powerful antioxidant, which protects the body from damage caused by harmful free radical molecules. CoQ10 is naturally present in small amounts in a wide variety of foods, but levels are particularly high in organ meats such as heart, kidney and liver as well as beef, soy oil, sardines, mackerel, and peanuts.

CoQ10 is known to be good for heart health. Several clinical studies suggest that CoQ10 may lower blood pressure. As well people with high cholesterol tend to have low CoQ10. (Although it has yet to be proven that low CoQ10 is the cause) There’s evidence that CoQ10 may help treat heart failure when combined with conventional medications. One clinical study found that people who took daily CoQ10 supplements within 3 days of a heart attack were less likely to have subsequent heart attacks and chest pain. They were also less likely to die of heart disease than those who did not take the supplements.

It is known that administration of the cholesterol-lowering drug class called 'statins' has been associated with a reduction in CoQ10 levels leaving people deficient. Sadly, most doctors prescribing statin drugs do not tend to mention this to there patients. There is some evidence that taking CoQ10 may reduce side effects of statins. Studies showed that CoQ10 decreased the muscle pain associated with statin treatment.

Note: in all of the above-mentioned conditions it is critically important that one must ask their doctor or cardiologist if it is safe for them to take CoQ10. It should not administered without supervision.


Supplements to Avoid

Fat Burners:

There are simply no legal fat burners that work. From carnitine to raspberry ketones to green coffee extract it just does not make a difference--- it does not really work to make a substantial weight loss change. They do “technically” work in that they do mildly enhance metabolism but does that translate into weight loss? No. The key to losing weight is to reduce stress, change to a healthier diet and exercise regularly. My advice is to see a Naturopath or Dietician who can help you learn to take a healthier lifestyle in order to significantly lose weight.


Targeted Supplementation

While everything we’ve covered so far has been for general health, there are a lot of supplements that work for very specific cases. For example, Tumeric can help with irritable bowel disease; Chastetree (Vitex agnus castus) can greatly alleviate PMS symptoms. Garlic helps lower cholesterol levels. These are a few supplements that have been clinically shown to be useful for specific conditions.


It would take hundreds of pages to go over every single health condition and describe useful supplements for each. (I know as I have several 500 page books like this in my office) I would suggest that if you have a specific condition and you would like to see if there something that can help to make an appointment with your local naturopath, herbalist or nutrition expert and see if they can suggest a supplement  that is right for you.

To Health,

Dr. Anders Nerman, N.D.

 

Dr. Anders Nerman, N.D. is a Naturopathic Doctor with an Integrative Family Medical practice in Wolfson Medical Center in Jerusalem, Israel. For more visit www.drnerman.com or call 972-54-427-8667.

Information is provided for informational purposes only and is not intended as a substitute for the advice provided by your physician or other healthcare professional. Always speak with your physician or other healthcare professional before taking any medication or nutritional, herbal or homeopathic supplement, or adopting any treatment for a health problem.


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Dr. Anders Nerman’s Vitamin and Supplements Guide Part 1

5/1/2014

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People often ask me what I think about taking supplements. In truth, I honestly believe that supplements are not the best way to get our vitamins and minerals. I prefer to help my patients understand how to get the critical nutrients they need from the foods they eat. The problem is however, that people are not eating well. It is a reality of our culture. Our modernized society and time pressured lives have created a lifestyle where we eat a lot of easy to obtain refined, whitened, processed foods that are much more deficient in vitamins, nutrients and minerals than the whole food diets of the past. The recognition of this deficiency led many world governments to mandate that vitamins like riboflavin and folic acid be added to the foods we eat. We don’t seem to have the time or the money to prepare nourishing foods. It’s a major problem. So with that in mind and based on evidence based scientific research I offer you this quick reference guide to taking vitamin and supplements.

One Caveat:

I do not talk much in this blog about dosages because I feel that vitamin dosages are patient specific. That being said, one can easily obtain a list of the recommended daily intake (RDI) values.  These values differ if you are male or female, a child or pregnant. I would suggest however, that everyone talk to their naturopathic doctor, nutritionist or medical doctor specifically about what they would like to try and why before starting to take supplements. This is because vitamins can be dangerous when taking with certain medical conditions and some vitamins interact with other medications you might be taking. This is why it is always important to discuss your supplements with your doctor. So please be cautious when taking supplements and get guidance from a licensed professional.

I wrote this article to help educate about some common deficiencies, and possible medical benefits that can be found by using vitamin and mineral supplementation.


The Multivitamin


Although this is the most popular supplement, it is considered by many alternative medical practitioners as one of the most overrated. Multivitamins are a good idea in theory but multivitamins have some major drawbacks. A multivitamin usually does not contain enough of each vitamin for that vitamin to have any effect. As well, taking a multivitamin might provide you with more than enough of certain vitamins like Vitamin C which is already very plentiful in most peoples diets and not enough of the vitamins many people are deficient in like Vitamin D. I don’t recommend multivitamins unless a patient has a very restricted diet and really cannot afford to purchase more than one supplement.


Common Vitamin Deficiencies

The following are a list vitamins people are commonly deficient in:

Vitamin D

Vitamin D is currently a very popular supplement and this is for good reason: most people are deficient in Vitamin D and it is very important for our health.  Vitamin D is different from other essential vitamins because our own bodies manufacture it through our exposure to sunlight.  Since sunshine is somewhat limited during certain months in the UK and since most peoples bodies are not uncovered most of the time, Vitamin D can be somewhat difficult to acquire.

The main function of vitamin D is to regulate the absorption of calcium and phosphorus in our bones (bone health). It also plays a critical role in healthy immune function. If you or someone you know has constant colds and flus it may be due to low Vitamin D status. It has also been shown to help maintain healthy body weight, reduce the risk of heart attacks and some cancers. Interestingly, it has been shown to prevent the natural cognitive decline in aging. Ask your doctor to test your Vitamin D levels and if deficient take it as a supplement.


Calcium

Calcium deficiency tends to be common in older people and those that don’t consume much dairy. Calcium is crucial for bone health. I prefer if patients focus on getting their calcium from non-dairy sources if possible. Foods like Bok Choy, Spinach, Collard greens, Almonds, Salmon and canned sardines are high in Calcium. If however, you do not think you can eat these very often then perhaps take a calcium supplement.



Magnesium

Magnesium has a role in the body in helping with the proper function of many of  our enzymes, it also works as a muscle relaxant. In fact, magnesium deficiency is often associated with muscle pain and spasm; especially back pain.

Magnesium is hard to obtain in our diets, because it is mainly removed with processing - so only whole unprocessed food contain it. Good magnesium sources are nuts, tofu, soybeans, figs, and unrefined whole wheat or rye bread. If your diet is lacking in magnesium, definitely consider supplementation. It also works wonders in helping people suffering from constipation get relief. As well magnesium is depleted by stress and coffee. Magnesium deficiency has been found in people suffering from Fibromyalgia and they will benefit from it in its magnesium malate form or a mixture of citrate and malate. I prefer Magnesium citrate as the supplement form of choice for most people.



It is important to note that people can often get Magnesium, Calcium and Vitamin D in one supplement. In my opinion this may be a better supplement to take than a multivitamin since it is these vitamins in which we are most likely deficient.

Iron

One of the most common mineral deficiencies in the world is iron. A direct consequence of iron deficiency is iron deficiency anemia. Iron works is a part of the molecule hemoglobin and therefore is crucial to proper red blood cell function.

People suffering from iron deficiency mostly tend to be women. It is usually low in vegans and some vegetarians as well.   Symptoms of iron deficiency are tiredness, moodiness, restless leg syndrome, muscle weakness, hair loss and impaired concentration. Some good food sources are meat, poultry, fish, leafy green vegetables, beans, whole grains, and blackstrap molasses. Iron supplementation is usually handled medical doctors, as overdosing can be toxic. Ask you doctor to test your iron and if low make sure to take a supplement.

Zinc

Zinc is involved with over 200 enzymatic reactions in the body and is critical for proper genetic expression and cellular division. Zinc deficiency is not rare because Zinc is hard for many people to absorb. It is critical for fertility in men, and for immune function in general. Signs and symptoms of Zinc deficiency is often loss of taste and smell. Excellent sources of Zinc are Meats, Eggs (mostly in the yolk), wheat bran, buckwheat, millet rice bran, whole wheat flour, oatmeal, brown rice and corn meal. It can also be found in black-eyed peas, green peas, garbonzos, lentils, limas, pumpkin and peanuts seeds, Spinach, Sweet corn, and Onions. The best form of zinc is the highly absorbable zinc picolinate. Zinc and copper compete in the stomach for absorption so any supplement you take of zinc longterm should also include a small amount of copper.


In my blog next article (Part 2) of Dr. Anders Nerman’s Vitamin and Supplements Guide, I will be discussing some other important supplements to consider taking for general health and will be identifying some supplements that are a fad and do not work. I will also be giving information on targeted supplementation for specific disorders.

To Health,

Dr. Anders Nerman, ND

Dr. Anders Nerman, N.D. is a Naturopathic Doctor with an Integrative Family Medical practice in Wolfson Medical Center in Jerusalem, Israel. For more visit www.drnerman.com or call 972-54-427-8667.

Information is provided for informational purposes only and is not intended as a substitute for the advice provided by your physician or other healthcare professional. Always speak with your physician or other healthcare professional before taking any medication or nutritional, herbal or homeopathic supplement, or adopting any treatment for a health problem.


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    Dr. Anders Nerman, N.D. is a Canadian-trained Naturopathic Physician living and practicing in Jerusalem, Israel.

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