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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Alternative Treatments for Irritable Bowel Syndrome:

12/31/2013

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Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder characterized by altered bowel habits (diarrhea and or constipation) and often-severe abdominal pain, bloating and gas. According to most western medical literature IBS is a chronic disorder of unknown cause.

Irritable bowel syndrome (IBS) is the most common gastrointestinal disorder. As well, IBS is one of the most common medical problems seen by physicians and accounts for up to 12% of total visits to primary care providers. Since IBS is such a common problem, I thought it was important to discuss the many clinically proven alternative medical treatments naturopathic medicine has to offer people with IBS.

How is IBS diagnosed?


IBS is a diagnosis of exclusion given by medical doctors when it is clear that a patient does not have a more serious gastrointestinal problem like Irritable Bowel Disease (Crohns or Ulcerative Colitis), Celiac disease or a dysenteric infection. Once more serious possibilities are ruled out, a person will likely be given the catchall diagnosis of Irritable bowel syndrome (IBS).

Is IBS real or all in the head?


There is clear evidence that IBS is real. Research has shown there to be measurable differences between a person with IBS and a person without it:

·       Low grade inflammation: Irritable Bowel syndrome patients show no identifiable inflammation when samples of their colonic tissue is looked at under the microscope, however some people do show increased production of inflammatory chemicals suggesting low grade inflammation is present but not seen.

·       Altered gastrointestinal tract motility:  Studies have shown that there are significant delays found in the mechanisms involved with the movement of food through the digestive tract in people who suffer from IBS.

·       Altered Bacteria in the Gut: Studies have found patients with IBS produce significantly more hydrogen in their stomachs than people without IBS. The colonies of bacteria found in IBS patients have less “good” bacteria such as bifidobacteria and lactobacilli and higher concentrations of the bacteria enterobacteriacae.

·       Enhanced Internal Stomach Perception: Patients with IBS have been found to more awareness of sensations in their guts than people without IBS.

Are Some People More at Risk than Others for Developing IBS?

The following are a few risk factors that have been shown to increase the likelihood of acquiring IBS.

·       Genetic: It has been shown that people have a genetic predisposition to acquiring IBS.  IBS is not predisposed by having a parent with IBS, but by having a parent with alterations in their nervous system’s response to external stimuli.

·       Previous Gastrointestinal Infection: It appears to that about 10% of people with IBS acquired it following an episode of dysentery.

·       Antibiotics use: Two studies have found an association between antibiotic use and increased frequency of IBS symptoms. This may be because the antibiotics altered the gut bacteria or that the antibiotics caused damage and inflammation to the gut lining.

·       Stress: Stress and traumatic life events have frequently been reported to have preceded the initial onset f IBS symptoms and symptom flare ups in patients suffering from IBS. Additionally IBS has consistently been found in patients with depression, panic disorders, and generalized anxiety disorder.

What do Western Doctors do for IBS?

Many agents are currently being used in western medicine for the treatment of IBS and no one agent has been proven particularity effective. The therapeutic gain (difference in treatment response between placebo and the active therapy given) has been minimal with these agents. As well, there are adverse side effects to many of the drugs given and therefore it is worthwhile to investigate natural medical treatments as a possible alternative to pharmaceutical agents. 

What Are Some Alternative Solutions to IBS?

Probiotics:

As mentioned above, there has been shown to be colonies of abnormal gut bacteria in the intestinal tracts of people with IBS. This is occasionally due to heavy antibiotic use where the concentrations of beneficial bacteria decrease and the numbers of harmful bacteria rise. Bad bacteria cause gas and putrefaction of food, and diarrhea.  Therefore one of the key therapies now being regularly employed in the treatment of IBS is the use of probiotics (good bacteria).

Probiotics which contain good bacteria such Lactobacillus acidophilus are a useful choice in IBS as was shown in studies as early as 1955. A systematic review and meta-analysis of randomized, controlled trials found probiotic use to be associated with improvements in IBS symptoms compared to placebo and to produce a real reduction in abdominal pain. Efficacy in IBS has been shown to be dependant on the type of bacterial strain. L. fermentum and L. plantarum are two strains that have shown in studies to be very helpful in IBS.

Where can I get Probiotics?

Fermented foods (yogurt, kim chi and sauerkraut) are a great natural source of probiotics.  One can also simply take probiotics in capsules, tablets and powder form.  In my opinioned power form probiotcs are the most effective for results in IBS as they work in the upper intestinal tract, don’t have binders, and can be incorporated into food and drinks easily. Unfortunately, they have a much higher cost than fermented foods.

Fiber:

A recent systemic review and meta-analysis found fiber to significantly improve IBS symptoms especially in IBS where constipation is the predominant symptom. Note however that it did increase abdominal pain somewhat. Soluble fibers like ground flaxseeds, slippery elm powder, psyllim husks, and oat bran have been found to be most effective.

Fluid Intake:

Adequate fluid intake is very important in the treatment of IBS. This would be 2-2.5 litres of water/fluid a day.

Exercise:

Has been shown to significantly lessen the constipation associated with IBS. It also relieves stress and improves mood.

Herbal Medicine:

There are many herbs that are very helpful for the treatment of IBS. Some are used to help stop the diarrhea or alternatively to increase motility or act as a laxative in constipation. Others herbs help sooth the digestive tract in general.  It is also possible to use herbs that help deal with stress by supporting the nervous system, which can decrease the intensity of the IBS symptoms. A proper herbalist or Naturopathic Doctor trained in herbal prescribing can come up with the right formula to manage the symptoms of IBS for each individual case.

Special Herbal Note: Tumeric

Turmeric, the common spice, acts as anti-inflammatory agents in the gut. Turmeric in particular, was found to significantly reduce abdominal pain and discomfort in IBS.

Diet:


It is not surprising that people who come to me with irritable bowel syndrome (IBS) want to know if a food they consuming might have some influence on the IBS symptoms. Many people know already that their signs and symptoms worsen when they eat certain foods. The verdict is not out on the role of food intolerance in irritable bowel syndrome. From my clinical experience however, and the clinical experience of many practitioners in my profession it is clear that eliminating problem foods from ones diet is essential in the treatment of IBS. There are good blood tests (IgG Antibody Food Intolerance Blood Tests) that can help a person find their problem foods by identifying which foods their bodies are having an immune response to. I use this test on a daily basis with my patients in my practice in Jerusalem.

Stress Reduction:

Yoga, Deep breathing exercises and mediation are all good ways to reduce stress which lessens the severity of IBS.

In conclusion, IBS is one of the most common complaints seen in a doctors office and yet it is one of the least understood problems. Western medicine offers very little in the way of solutions to this problem and the pharmaceutical drugs given have very little effect and adverse side effects. As noted, there are lots of evidence based clinically proven alternative treatments to IBS. If you have IBS maybe it is in your best interest to try some of the many natural alternatives available to help you resolve this issue once and for all!


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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The "Undiet" Book by Meghan Telpner

7/7/2013

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I can not begin to start to express my excitement when I read Meghan Telpner's new book titled "Undiet." Over the years I have tried to find good resources to give my patients to help them acclimatize themselves to a complete "holistic" diet transition, one that is so necessary for us all but seemingly so difficult without proper tools and guidance. I like this book because Meghan has amassed a ton of health information on optimal eating and repackaged it in a way that enables your Average Joe to get to the finish line of healthy eating. Meghan, the Toronto based self-titled "Nutritonista" has created such an awesomely useful book, that I had to recommend it. Dr. Nerman Approved! Anyone really wanting to change their lives for the better had better read this book!
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Find out if you have a Food Intolerance once and for all!

7/1/2013

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Do you think you might have a problem with a food you are eating but can not figure out which one?
I am now offering an IgG Food Sensitivity/Intolerance Blood Test at my office at Wolfson Medical Center! Within one hour we will be able to tell what foods you are reactive to!

I am using the latest technology in IgG-mediated food sensitivity reaction testing. We will test your blood to see if you are producing IGG antibodies to over 56 foods with results in just ONE hour. With just a small finger prick of blood you can finally figure out exactly what foods you are sensitive too!!

Test price is 499NIS.* Test and 45 min diet consultation based on results 650NIS.

Great test for children and infants as no large blood draw required, just a small finger prick of blood.

Book in for a FREE 15 min evaluation to see if this test could help you. Call 054-427-8667 to book an appointment.

Many people exhibit chronic food sensitivity reactions to specific food antigens. Unlike the immediate effects of IgE-mediated allergy, (the skin prick tests your allergist does) IgG- mediated food sensitivity reactions may take several days to appear. Controlled removal of the problem foods from the patient’s diet will, in many cases, rapidly improve the patient’s condition.

Fatigue, weight gain, dermatitis, eczema and arthritis are associated with food allergies. Irritable bowel syndrome may also be linked to food sensitivity.

*This is the price for the test alone without full visit.

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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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