all posts, eczema hacks, miscellaneous, treatments, women's health

policy and innovation around skin

blur brainstorming business close up
Photo by Pixabay on Pexels.com

A long while back I came across this article called From IUDS to IVT – Designing for Women’s Health on medium a while back, by Emilie Lasseron. In a nutshell, she talks about the new innovations in women’s health and how it is important for creators in this realm to be mindful of their audience. Naturally I tried to pattern match this to blend into the eczema realm as well, to combine my two interests/where I’m at in life now.

Lasseron’s big 5 bullet points were to “design:

for passive engagement”, which was where she explained how we have a culture where we don’t really think about fertility until we start trying. This is similar to what we see with eczema (with eczema being a negative thing that people don’t try but experience). People don’t really think much about it, until it starts to take over and disrupt their way of life.

for myths, not just the facts”, in which she explained that we have to meet people where they are at, even if that means from a perspective that may be incorrect or grounded in myths. This is huge for eczema. From dispelling the idea that we have contracted some contagion, to explaining that no, coconut will not cure the skin, there are so many “old wives’ tales” and other myths to slog through that when talking to someone new to having eczema, it’s important to be able to calmly and concisely explain the basics and why some of the commonly heard remedies may be wholly ineffective.

for the conversation women want to have with their doctor”, in which she described creating tools to help women feel comfortable getting their questions out to doctors and to help them reclaim their agency. Which is also CRUCIAL with eczema. Patients with eczema are already feeling terrible about their skin. And so it is so important that they can feel able to openly talk with their dermatologist and not feel judged or scrutinized for their choices, where they are coming from in their educational journey, etc.

with as few assumptions as possible”, in which she talks about not assuming women know everything about their bodies (most of us don’t), and uses the example of a period tracker app that expected you to know your cycle length before you could sign-up (I never personally know how long my cycle is). This is like if there is an app made for eczema and it keeps requiring the patient to know exactly when the flare started, what we ate that day, how long we slept, did we encounter any new allergens, etc. It is hard to track all of these little life factors, especially if we didn’t think we were going to flare, or we are new to having to deal with severe eczema.

with side effects in mind”, in which she talks about making products that allow women to talk about/understand other side effects, an example being an app that tells you you may be more constipated during the luteal phase of your period. This would be the equivalent of an app that gets you to talk about various symptoms and co-morbidities of eczema like the oozing or the flaking or the infections, the isolation or depression, etc, so that it would be easier to identify:

  • one, what stage of a flare the person is in, and
  • two, what is most common, and therefore important to address (like increasing rates of depression).

All in all it was a fairly quick read and highlighted a lot of the innovation that is and needs to continue to happen within women’s health (and could be extrapolated to what innovation needs to happen in the eczema world too) to allow for better healthcare and treatment.

Speaking of innovation, I entirely missed hearing about this event: Make The Breast Pump Not Suck, a hackathon that happened in Boston April 27th-29th last year. It was hosted to try to address not just pump technology itself, but policies around maternity leave, breastfeeding spaces at workplaces, what barriers to breastfeeding exist, how to build community engagement, and getting stories from different women about their experiences. There were also community innovators mentioned who are doing awesome things in the field of women’s and maternity health (see here), including one in Boston called the Neighborhood Birth Clinic! The group is trying to open a free standing birth clinic in Dorchester. The event also highlighted different independent innovators like Melissa Hanna who created Mahmee, a secure platform that lets providers coordinate healthcare of both the prenatal and postpartum stages.

My dream is that there will be hackathons and the like for innovations with eczema too, besides just the Eczema Expo. And hey, if not, maybe that’s what I’ll work to pioneer one day.

all posts, eczema hacks, treatments

moisturizer withdrawal for eczema

person pouring plastic tube bottle
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Moisturizer withdrawal (MW) is a hotly controversial topic in the field of eczema (especially in regards to topical steroid withdrawal). The medical community generally is anti-MW, while there are some specific doctors and communities that are very much for it.

Some of the pros I’ve read about on giving up moisturizer include:

  • moisturizers seal in heat, which makes going through eczema/topical steroid withdrawal more uncomfortable
  • your skin produces cortisol naturally, but adding moisturizer can suppress this production (more on that in a bit)
  • you are losing so much skin (more in reference to TSW) that you don’t want to try to lubricate the dead skin and slow your body’s attempt to rid itself of the old tissue
  • most moisturizers have something in them (usually to help them be more shelf stable) that does not help the natural skin biome. As such, they may hinder healing because more resilient skin bacteria, ones that can survive the pH and chemical changes created by said moisturizers, are usually not the benign ones

I then proceeded to go down a rabbit hole in studies trying to understand more about the skin and its own ability to create cortisol (again this was more in reference to trying to understand how to overcome TSW more easily/quickly). The rabbit hole led me to read about keratinocytes and how our skin reacts to stressors.

Keratinocytes (a type of outer skin cell) can create cortisol in response to adrenocorticotropic hormone (ACTH), as studied in cultured keratinocytes (meaning keratinocytes on petri dishes or other lab-made mediums) and in human skin samples. Keratinocytes also make glucocorticoids (GCs) which are known to block wound healing, but also block pro-inflammatory cytokines (something we know run rampant in those going through topical steroid withdrawal). So, it’s my thinking that the GCs could help as a balancing factor with the excessive inflammation that comes with eczema and TSW. The amount of cortisol produced also changes in response to things like trauma and UV light and dryness. It was the dryness that intrigued me because with conditions like topical steroid withdrawal, we are taught to combat it by applying more moisturizers to prevent dryness, but what if that is decreased the skin’s ability to hit a homeostatic level and kick up its cortisol production?

In Japan, there is a doctor (Dr. Kenji Sato) known for his treatment of eczema and topical steroid withdrawal, and he works in a hospital (Hannan Chuo Hospital) on a program where people enter specifically for TSW and then they stay for an average of 40 days or so and then leave, supposedly healed. Note, they are healed from TSW, but they can still have eczema flares, though those usually aren’t as bad. I’ve been curious about his treatments for a while, especially because the regime doesn’t require strict diets, and the main things it requires are keeping your nails really short, exercising everyday, and not using any moisturizers (no soap, no lotions or creams or ointments, and any showers must be shorter than 1 minute). For those interested in the hospital, there were two comics I came across a while back that tell stories of what it was like to be a patient at this hospital. The first is done on the artist’s personal experience, and the second was created after an interview with a fellow patient.

Personally, I am starting to think moisturizer withdrawal may be the way to go (for myself). I’ve noticed that I itch horribly after baths and sometimes showers, and itch even worse when I put on my lotion or creams on wet skin (which is usually the recommendation of the medical community to help seal in the moisture). To be fair, I do tend to take baths/showers that are too hot by those same medical recommendations, but water tends to cause me pain at any level of exposure so I think I enjoy hot water because it’s a different pain sensation so it blocks out the burning of open wounds.

After thinking about it, as it is currently winter in Massachusetts, this would be a terrible time to go through moisturizer withdrawal. My skin tends to fissure something horribly when it’s dry and especially in winter/when indoors with the heat on. I will think about going through MW in the spring/summer and post about a 40 day trial then.

 

REFERENCES

Cirillo N, Prime SS. Keratinocytes synthesize and activate cortisol. J Cell Biochem. 20011 Jun; 112(6): 1499-1505.

Zhu G, Janjetovic Z, Slominski A. On the role of environmental humidity on cortisol production by epidermal keratinocytes. Exp Dermal. 2014 Jan; 23 (1): 15-17.

Vukelic S, Stojadinovic O, Pastar I, Rabach M, Krzyzanowska A, Lebrun E, Davis SC, Resnik S, Brem H, Tomic-Canic M. Cortisol Synthesis in Epidermis is Induced by IL-1 and Tissue Injury. J Biol Chem. 2011 Mar 25; 286(12): 10265-10275.

all posts, eczema hacks, treatments

“how doctors think” about eczema

assorted doctors tools
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A few weeks ago I finished a book called How Doctors Think by Jerome Groopman and oh boy do I have thoughts. First off I have to say that the book had its fair share of  downer moments because it had a lot of cases of patients with cancer who struggled with doctors to find plans of care that extend their life just a bit more.

But other than that it was full of all kinds of information about different schools of thought that doctors employ to help their patients. Two specific ones it mentioned included the evidence-based and algorithm-based approaches.

With the evidence-based approach, the doctor relies on existing research, especially those that have a large amount of studies behind them. The issue with this approach is that doctors often default to using said heavily-backed solutions without inquiring or considering less numerously-backed ideas. This could become a problem, say if a new drug has tens of studies done on it, all sponsored and paid for by the company that produces the drug, while an alternative medicine or treatment may have great results but only a handful of studies supporting it, In that scenario, it’s almost more of a research field monopoly,  rather that robust results that gives the drug the good reputation, causing the doctors to favorite it more. In relation to eczema, where these ideas can be applied is in understanding how to approach doctors in a way that doesn’t cause them to default to automatically prescribe topical steroids (the long standing, most heavily-researched atopic dermatitis prescription option) as the first line of action.

With the algorithm-style approach, the doctor can follow a flowchart style of logic that’s been proven relatively effective over time. Its basically like having a graph that has arrows from each option to a few subsequent options, like:

“Does the patient have X cluster of symptoms?

  • Yes = Prescribe drug A.
  • No = Run test 1.

Is test 1 positive?

  • Yes = Give drug B.
  • No = Run test 2.”

And so on, and so forth. The flaw with this approach is that it doesn’t allow the doctor to think outside the box, which Groopman argues can result in said doctor trying to fit a patient nicely into an existing “flowchart” result, even if there are some signs or symptoms that don’t quite match up with that diagnosis. This may be the case when someone has other co-morbidities too or when someone has common symptoms of two very different diseases (like this example of a woman who was using topical steroids and found out she had lymphoma). For this problem it can be useful to ask the doctor what are the best and worst case scenarios of diseases that fit the presentation of symptoms. Asking this can help a doctor think beyond their initial conclusion and more thoroughly work to rule-out other options.

Another significant point the author makes is that for doctors to really become better, they must remember their mistakes and use that vulnerability to inform their care. He gives examples of renowned doctors who literally have binderfuls of their mistakes that they reference to maintain humbleness and act as a forcing function to always push themselves to improve. This might be a more difficult conversation to have with your doctor as I imagine no doctor enjoys being asked, “so let’s talk about all the times you royally effed up with patients”.

One last subject the book addresses that I’ll bring up is the pressure doctors implicitly face when they accept any form of samples or gifts from big pharma companies. It’s not that all pharma-marketed medicines are bad, but that you want your doctors’ reasons for choosing a specific product to come from no other influence than that they believe it works and have seen that said products have good efficacy. This is why it can be hard to decide whether or not to use samples a doctor gives you as you don’t know that they really think it works or if they just happen to have them around from a sales pitch. A question to ask in this case might be “have you seen a lot of positive outcomes from use of X product?” Another way to foray into this territory with a doctor is to ask about long-term results, as well as what are any known side effects (this could apply to eczema-related products like topical steroids to non-steroidal creams or biologics or brand-name moisturizers). If something sounds too good to be true, it’s probably fairly new to the market and so the longevity of effects haven’t been tested. A further question to ask is if there are any cheaper off-brand equivalents because those usually only come out after something has been on the market for a while.

These are just a few of the points that the book made, that I’ve tried to connect back to how to talk with your dermatologist about eczema. There are more factors involved that could make the process more convoluted or impossible in some instances, but I do think these provide a light foundation to attempt to build a stronger relationship with the right doctor.

Speaking of the right doctor, I have an older post that goes more into making sure you feel comfortable and that you have a good rapport with your doctor, which was another huge point Groopman made in the book. He explained that a patient who is difficult to treat, simply by having complex issues that don’t respond to more common treatments, often ends up being resented by the doctors, and as a result gets worser care. The suggestions in the book for overcoming these kinds of doctor-patient relationship issues is to say something like, “I know my condition is difficult” or “I feel like we got off to the wrong start” to help try to make the doctor aware of their negative emotional bias.

On the flip side, a patient that the doctor likes too much may also get worse care if the doctor makes overly sympathetic emotion-based decisions like skipping tests to not inconvenience the patient or by avoiding procedures that may cause the patient pain, etc. To overcome this issue, it can be as simple as saying “please treat me like you would a patient you knew nothing about”, and hopefully that should provoke the doctor into making sure they’re as analytical and diagnostic as possible again.

I’d love to hear about any particular experiences you’ve had with your dermatologists in the comments, and whether or not you agree with my suggestions, and also from any doctors out there reading this.

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do you detox? (or fast? or supplement?)

sliced lemons
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“Hello darkness my old friend”… today’s post was started during the witching hours of the night, not because of insomnia (yay, progress!) but because of Fi-somnia… aka my 4.5 month old baby, Fiona. She’s a much cuter reason to have a disturbed REM cycle.

Anyway let’s talk about the health elephant in the room: detoxing. I have heard more and more talk about various detoxification methods and I am just not sure what it all means, so today’s post is about clearing my system (pun intended) of these questions.

First off, what are the theories around detoxification? One theory I have heard for those who have eczema goes as followed: our organs (specifically the liver and kidneys) become over-taxed by our modern diets and exposure to heavy metals and other toxins, and at some point it becomes all too much and our bodies cannot flush-out said toxins, so instead, the build-up of toxins show off their toxic love by wrecking our skin.

Now going by that theory, let’s quickly delve into the soup to nuts details of how detoxification works in the body in general by addressing (very quickly) specific organs.

  • Liver: works by changing toxins into less harmful substances and/or helping the body flush out toxins
  • Kidneys: remove waste and acid build-ups from blood into our urine to be flushed out of the body
  • Intestines: helps to remove toxins via waste or vomit
  • Lymph system: transports its white blood cells throughout the body
  • Respiratory tract: the lungs remove gases from our bodies
  • Skin: (when intact) prevents some toxins from penetrating into the body

So from there, let’s address some specific detox methods I’ve heard about including the watermelon detox, the lemon detox, etc. My internet researching first led me to a review done in 2014, which reported that there wasn’t much evidence to show that detox diets actually work. It indicated that studies that said otherwise usually had flaws in their methods or too few people tested (aka small sample sizes, which is a problem because then you can’t reasonably assume the results will work for a much larger group).

I then looked more for studies, but before I talk about them, let’s backtrack and talk about studies that investigated how detoxification naturally works in the human body (and/or animal bodies). First I wanted to figure out what organs have been studied to hold toxins. A study done in 2007 on African catfish showed how the livers, kidneys, and hearts of the fish ended up storing high concentrations of heavy metals (zinc, lead, arsenite, cadmium, and copper) presumably from pollution entering the water nearby. I’m not sure if the same organs are seen to hold toxins in the case with humans, but given how often we hear livers talked about in the same sentence as detox diets, I’d venture to say yes. I then actually looked up via the CDC, about organs and toxic exposures for humans, and apparently all organs can be affected. Well then, how do our bodies avoid full spectrum toxicity?

Well, bodies have some ability to create compounds out of heavy metals, to bind them chemically to make them less dangerous to the body (which is the function of the liver, remember?), as was supported in a study in 2004 on seals, porpoises, and albatross. Generally heavy metals can end up in cells in the body: in the cell’s fluid, mitochondria, nucleus, etc (in the case of the study, they were talking about liver cells). But how specifically do bodies deal with heavy metals; or in other words, what gets the liver to start neutralizing these toxins? A study done in 2004 on mice looked at something called the metal responsive transcription factor 1 (or MTF-1)Side note: a transcription factor is a protein that helps turn on/off genes. The study’s results showed that a developing fetus that lacks Mtf1 (the gene that MTF-1 can turn on/off) will die because its liver won’t be able to form properly, but an adult that lacks Mtf1 will have difficulty handling heavy metals and will have low lymphocytes (the cells that help clear bad germs and materials out of our blood). This MTF-1 also is used to deal with when the body has hypoxia (not enough oxygen) or oxidative stress (too many free radicals in the body). What this all means is that our liver is able to function properly because it has this protein that turns on whatever genes are needed to get the liver to deal with toxins (metals and free radicals).

Now let me also quickly talk about oxidative stress, which is important to note because heavy metals can cause oxidative stress. That may be why and where the idea of some detox diets came from: if you want to detox from free radicals in the body, doesn’t it seem logical to consume antioxidant-rich foods and nothing else for a few days to cleanse? And what foods are known to have good supplies of antioxidants? Watermelons, lemons, and many fruits and vegetables that we see juiced into detox juices. So using that line of thinking I now move on to trying to better understand the support behind specific cleanses.

First I searched for the lemon detox. There’s a study that was done in 2015 on overweight Korean women that tested the lemon detox drink (a lemon, maple syrup, and palm syrup combo) versus a placebo drink versus a normal diet for 7 days followed by 4 days of food transition. According to the abstract of the study (which was all I could access freely) both the placebo and lemon drink resulted in improved BMI, body weight and body fat, as a well as improved serum insulin levels and insulin resistance scores. Hemoglobin and hematocrit levels were unchanged for those on the lemon diet, while a protein called serum high-sensitive C-reactive protein (hs-CRP) was reduced. What I am unsure of, is if the hematocrit and hemoglobin levels were within a normal range to start for the participants (which is important to know because too low indicates issues like anemia/low iron in the blood; too high can be a signal of dehydration among other things). The researchers concluded that going on a lemon drink detox for 7 days improves body fat and insulin resistance. The reasoning behind why however, they said was because the lemon detox drink is low-calorie, so essentially you are just burdening your digestive system less. So it’s more likely the fasting component that helps rather than the lemon drink having a cleansing effect.

What about watermelon? A study done on rats in 2015 indicated that a diet of watermelon helped reduce the effects of laboratory-induced type 1 diabetes. The procedure involved the rats fasting for 24 hours before being injected with a solution (alloxan) to induce diabetes, and then being fed watermelon extracts for a week. The rats given the watermelon extract had improved weights and reduced blood glucose concentrations, among others changes that caused the watermelon-fed rats to more closely resemble the control (healthy) rats, than the diabetic rats.

Thus my overall concluding thoughts on detoxing so far, are that:

  1. If you are consuming fewer calories, innately you are taxing your digestive system less so you’ll have a natural “detox” effect,
  2. With fewer things in your digestive system, the effects of consuming foods that are rich in antioxidants probably does help remove free radicals. It also probably therefore lets your liver bind toxins and your kidneys remove waste more effectively, and
  3. If detoxing is therefore being used synonymously with fasting, then there is a lot of evidence that it works. Fasting has been studied to, when done safely, be beneficial for everything from diabetes and obesity to other autoimmune disorders.

The reason I brought up point number 3 is because there are studies done on lemon juice and other popular detox foods that don’t include fasting, but rather just adding said food to a person’s existing diet. One such study done in 2016 tried such an experiment, by adding lemon juice and garlic to participants diets, and their results included decreased cholesterol, reduced blood pressure, and reduced BMI. In Jason Fung’s book Obesity Code, he mentions how drinking two tablespoons of apple cider vinegar in water before bed helps lower your blood sugar levels while you sleep. So then one can beg the question of, are we seeing improvements to health more so because fasting allows our bodies to “catch up” and get rid of toxins, or because we are lacking nutrients and so when we supplement them we see positive outcomes to our health?

Backtracking for one last comment on juicing and raw vegetable/fruit detoxing. A study done in 2017 looked at the effects of a raw juice diet of 6 drinks a day for 3 days, varying the juices throughout, and saw a lot of positive results in changes to the gut microbiota, increasing microbiome species correlated with weight loss and other aspects. The issue still stands of whether or not it’s the food types themselves that are included in the juices, or the fasting aspect (as one consumes a lot fewer calories when juicing), that provokes said positive results.

Honestly, in my humble opinion, it doesn’t actually matter which answer is correct because if you are safely fasting on occasion (and/or reducing calories), and consuming healthy options with lots of vitamins and minerals while doing so, does it really matter which aspect is to praise for the good results?

Ending note: I hope this was apparent, but, the intention of this post isn’t to target people who do or don’t do detox diets but merely to satisfy my curiosity. I had heard a lot of anecdotal experiences on the matter and so I was curious to hear about the results from more formal studies as well. Whether or not you choose to detox is your own prerogative.

 

REFERENCES

Aslani N, Entezari MH, Askari G, Maghsoudi Z, Maracy MR. Effect of Garlic and Lemon Juice Mixture on Lipid Profile and Some Cardiovascular Risk Factors in People 30-60 Years Old with Moderate Hyperlipidaemia: A Randomized Clinical Trial. Int J Prev Med. 2016; 7: 95.

“Detoxification.” Partnership for Environmental Education and Rural Health, https://peer.tamu.edu/curriculum_modules/OrganSystems/Module_3/index.htm. Accessed 7 Nov 2018.

Farombi EO, Adelowo OA, Ajimoko YR. Biomarkers of Oxidative Stress and Heavy Metal Levels as Indicators of Environmental Pollution in African Cat Fish (Claris gariepinus) from Nigeria Ogun River. Int J Environ Res Public Health. 2007; 4(2): 158-165.

Henning, SM, Yan J, Shao P, Lee R, Huang J, Ly A, Hsu M, Lu Q, Thames G, Heber D, Li Z. Health benefit of vegetable/fruit juice-based diet: Role of microbiome. Scientific Reports. 2017 May 19; 7.

“How does the liver work?” Informed health Online, Institute for Quality and Efficiency in Health Care, https://www.ncbi.nlm.nih.gov/books/NBK279393/. Accessed 6 Nov 2018.

Ikemoto T, Kunito T, Tanaka H, Baba N, Miyazaki N, Tanabe S. Detoxification Mechanism of Heavy Metals in Marine Mammals and Seabirds: Interaction of Selenium with Mercury, Silver, Copper, Zinc, and Cadmium in Liver. Archives of Environmental Contamination and Toxicology. 2004 Sep; 47(3): 402-413.

Kim MJ, Hwang JH, Ko, HJ, Na, HB, Kim JH. Lemon detox diet reduced body fat, insulin resistance, and serum hs-CRP level without hematological changes in overweight Korean women. Nutrition Research. 2015 May; 35(5): 409-420.

Klein AV, Kiat H. Detox diets for toxin elimination and weight management: a critical review of the evidence. Journal of Human Nutrition and Dietetics. 2015 Dec; 28(6): 675-686.

Oseni OA, Odesanmi OE, Oladele FC. Antioxidative and antidiabetic activities of watermelon (Citrullus lanatus) juice on oxidative stress in alloxan-induced diabetic male Wistar albino rats. Niger Med J. 2015 Jul-Aug; 56(4): 272-277.

“Taking an Exposure History: Which Organ Systems Are Affected By Toxic Exposure(s)?” Agency for Toxic Substances & Disease Registry: Environmental Health and Medicine Education, https://www.atsdr.cdc.gov/csem/csem.asp?csem=33&po=6. Accessed 6 Nov 2018.

“Transcription factors.” Khan Academy, https://www.khanacademy.org/science/biology/gene-regulation/gene-regulation-in-eukaryotes/a/eukaryotic-transcription-factors. Accessed 7 Nov 2018.

Wang Y, Wimmer U, Lichtlen P, Inderbitzin D, Stieger B, Meier PJ, Hunziker L, Stallmach T, Forrer R, Rülicke T. Metal-responsive transcription factor-1 (MTF-1) is essential for embryonic liver development and heavy metal detoxification in the adult liver. The FASEB Journal. 2004 Jul 1; 18(10). 

“Your Kidneys & How They Work.” National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/kidney-disease/kidneys-how-they-work. Accessed 6 Nov 2018.

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why you might want to follow news on filaggrin

yellow health medicine wellness
Photo by Pixabay on Pexels.com

I mentioned in a post last week that I was reading a book called Living with Itch by doctors Gil Yosipovitch and Shawn G. Kwatra. Well I’ve since finished it and determined it’s another book that I think everyone should read.

While reading said book I came to the following image:

2018-10-28 09.50.04

As I stared at my own palms, which do look remarkably like that illustration (as in I would make a palm reader dizzy trying to interpret all my lines), I pondered about this protein, filaggrin, and about all of us filaggrin-lacking individuals. This led me to wonder if there were existing treatments out there to replace filaggrin in those deficient.

But first, I had to understand what filaggrin does. Cue google scholar searching for studies! Filaggrin is a protein that binds keratin fibers together. Keratin is the protein that helps create the structure of the outer layer of our skin (and nails and other things). So not having functioning filaggrin means that outer skin barrier is not as strong and impervious to the external environment (germs, mechanical stressors like scratching, chemicals, temperature, water retention, etc).

Armed with that knowledge I did a cursory search which brought me to two studies, one in 2014, and one brand spanking new one done this year. The 2014 one looked into filaggrin injections, but I’m getting ahead of myself. To start, the study (done presumably in Europe as it talks about Europeans in particular and as I could only access the study’s abstract) gives background information that 1 in 10 European people have this filaggrin (FLG) loss of function mutation (or what they call a LOF mutation) and that so far this LOF mutation is the biggest genetic risk of atopic dermatitis. They also give other fun likelihoods like that someone with said mutation is more likely ” to develop asthma, to have more severe and more persistent disease, to have allergic sensitizations, and to develop eczema herpeticum”. At this point you may be thinking, ‘all of us FLG LOF’ers are off to a rough start!’ The study then went on to describe why they think filaggrin replacement therapy may help with eczema management (specifically atopic dermatitis, but I’m going to continue using the blanket term of eczema from now on). Basically they talk about how gene replacement therapy of this protein is difficult because the protein is so large and they need to get it through the stratum corner layer of the skin into the cytoplasmic space for it to work. So instead of trying to inject the big protein into the skin, they did some science-magic and used some mouse genetic material linked to a compound that could penetrate cells (a peptide) to make a recombinant protein (which can help get a mutant gene to express the normal function, in this case getting filaggrin to bind keratin fibers together). They tested their work on cell cultures, flaky mice tails, and human skin equivalents and results showed that the flaky tails’ stratum corneum (the outermost layer of the skin) seemed to be restored. They ended the study by saying that there would need to be further studies to determine how safe this would be for humans, as well as things like how much to use, how well it works, and how long to use it, etc. They also noted that though mice didn’t have any problems with the foreign protein injected into their tails, that there is still a possibility that humans’ skin/immune system could reject the forgiven material.

The newer study, rather than trying to inject filaggrin into the skin, took the approach of trying to create a nutritional supplemental to ingest (as they were particularly interested in making a convenient and safe treatment, especially for children). They noted that an amino acid called L-histidine gets used in filaggrin production, and when the filaggrin gets broken down, the L-histidine is released and used as a natural-moisturizing factor (or NMF) and is said to “contribute to barrier function through skin hydration and maintenance of stratum corneum acidity” (hey look, skin acidity mentioned once again). This study also goes on to mention how eczema may be caused by either the FLG mutation or messed up profilaggrin processing but either way can lead to the skin barrier issues we see with eczema, and for either issue the L-histidine amino acid has a beneficial effect. Their overall results were that an L-histidine supplement once a day for 4 weeks showed positive changes to eczema and those benefits lasts even when the L-histidine was discontinued. They even said that their results indicated using the L-histidine was on par with using a mid-potency topical steroid while being steroid free (so none of the side effects)!

Both the L-histidine supplement and the filaggrin injection sound extremely promising and exciting for the world of people living with eczema, though I, in particular am leaning towards the supplement, if I had my pick (I would love to be part of the study for L-histidine, but that will have to wait until I’m done breastfeeding).

 

REFERENCES

Irvine AD. Crossing Barriers; Restoring Function? Filaggrin Protein Replacement Takes a Bow. Journal of Investigative Dermatology. 2014 Feb; 134(2): 313-314.

Sandilands A, Sutherland C, Irvine AD, McLean WHI. Filaggrin in the frontline: role in skin barrier function and disease. J Cell Sci. 2009; 122: 1285-1294. 

Tan SP, Brown SB, Griffiths CEM, Weller RB, Gibbs NK. Feeding filaggrin: effects of L-histidine supplementation in atopic dermatitis. Clin Cosmet Investig Dermatol. 2017; 10: 403-411.

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what on earth is seed cycling?

black and brown peppercorns spilling from glass jar
Photo by Dids on Pexels.com

Today’s post may feel a bit out there, but that’s why it’s also nestled under my “miscellaneous” category. So, having absolved myself of all guilt for anyone who misinterprets this post as hard fact, I begin.

I recently saw the term ‘seed cycling’ used on social media and became intrigued as to one, what it meant, and two, what benefit it had (if any).

A quick Google search led me to both answers. Seed cycling is somewhat literally what it sounds like (although my first guess as it was 4am as I wrote this, involved interpreting cycling as bicycling). You cycle between seeds in your diet, consuming specific ones at specific types during your menstrual cycle (and supposedly it can be use for peri-menopausal and post-menopausal women as well).

Anyway, the theory is that a menstrual cycle is most naturally working if it is within the 28-day cycle, and anything else indicates some sort of imbalance of estrogen. The seeds chosen during the two phases of the menstrual cycle (when estrogen is decreasing and when it is increasing) are chosen specifically to help balance out the estrogen in each phase to allow the person to resume the natural cycle duration.

At this point you may be wondering why am I posting about this on my eczema blog? Well, you may recall from my post on pregnancy, that one of the factors believed to provoke eczema in pregnant women is the surge of estrogen. So my hypothesis is that if one’s cycle is off, and they experience larger ranges of estrogen surges during phases of their cycle, perhaps that would increase the intensity of an eczema flare.

Here’s a quick overview about the menstrual cycle (I previously worked as a women’s health consultant, so I both enjoy this kind of knowledge and could use the refresher myself). We have 4 phases: menstruation, the follicular phase, ovulation, and then the luteal phase.

  • MENSTRUATION – This is the phase in which the lining of the uterus (or the endometrium), which has thickened over the month, comes off and there is bleeding from the vagina.
  • FOLLICULAR PHASE – This phase starts on the first day of menstruation. The pituitary glands, triggered by the hypothalamus, release follicle stimulating hormone (FSH), and FSH in turn causes the ovaries to release a few follicles, each of which has an egg. One of these follicles’ eggs will start to mature, while the others die (around day 10). The uterine lining starts to thicken during this phase too due to follicular stimulation. The follicular growth also causes a surge in estrogen, which the body compensates for by the hypothalamus releasing gonadotrophin-releasing hormone (GnRH), which gets the pituitary gland to release lutenizing hormome (LH) and FSH.
  • OVULATION – During this phase, the high levels of LH triggers the release of the mature egg from the ovaries in two days. The egg is propelled by little hair-like structures through the fallopian tube into the uterus. Once there, it can survive for only about 24 hours. During this process, the egg has “hatched” out of the follicle, and the follicular remnant that gets dragged along outside the egg becomes the corpus luteum. The corpus luteum releases progesterone and a little estrogen, a mixture that helps keep the uterine lining thickened.
  • LUTEAL PHASE – During this phase the corpus luteum releases progesterone and a little estrogen, a mixture that helps keep the uterine lining thickened. When no pregnancy occurs, the corpus luteum falls off and dies (around day 22), causing a drop in progesterone. The progesterone drop triggers the uterine lining to fall off (aka menstruation), hence the cycle repeats.

So how does one do this seed cycling, you ask? Well, during the follicular phase (day 1 when you start to bleed to day 14) you take a daily dose of 1 tablespoon of ground flax/pumpkin/chia seeds. From days 15-28 you take a daily dose of tablespoon of ground sunflower/sesame seeds. That’s all there is to it.

But why is this supposed to work? I couldn’t find any rigorous studies on seed cycling, but came upon a blog post written by a naturopathic doctor (Dr. Lindsey Jesswein). She explains that the seed hulls have chemicals called lignans, which help “modulate hormone pathways”, and the seed oils (made of omega fatty acids) help “provide the building blocks for steroid hormone synthesis”. Jesswein then describes each seed (minus chia) a bit more by what they provide:

  • Flax – vitamin B, manganese,  and magnesium
  • Pumpkin – iron, magnesium phosphorous, zinc
  • Sesame – vitamin E, vitamin B1, manganese, irin, magnesium, copper, sesamin
  • Sunflower – vitmin E, linoleic acid, magnesium, potassium, zinc, calcium

The Herbal Academy (which was how I came to Dr. Jesswein blog post) goes into a bit more detail about the various benefits of each of these seeds and provided studies, but noted that the information was on individual seeds and not their impact with seed cycling.

A few of the studies they included (and some additional ones I found) found that:

Overall the evidence of large changes for the menstrual cycle is not huge, but at the same time, it generally doesn’t hurt to consume seeds in one’s diet so it may be worth trying if you want to play around with your nutrition (though always seek advice from a medical professional first, especially if you have a specific condition you are trying to treat!).

I’m curious to apply seed to myself so I might give it a trial for a few months and report back. Maybe. I’m also incredibly fickle, so probably not. I generally eat flax anyway with breakfast and the like, but I wouldn’t be able to notice if there were any changes because I’m still breastfeeding and thus not getting my period anyway.

Also I do understand that engaging in many different eczema projects simultaneously results in confounding the data as to which project individually helps my eczema, but it is my belief that eczema cannot be managed by just one miracle solution (though diet is a huge one) and so enacting multiple positive changes and approaches, so long as they are sustainable to myself lifestyle, I view as being the most maximally beneficial.

 

REFERENCES

Gossell-Williams, M., Hyde, C., Hunter, T., Simms-Stewart, D,. Fletcher, H., McGrowder, D., Walters, C.A. (2011). Improvement in HDL cholesterol in postmenopausal women supplemented with pumpkin seed oil: pilot study. Climacteric. 2011 Oct;14(5):558-64.

Hall, Annie. “Seed Cycling for Hormonal Balance.” Herbal Academy, https://theherbalacademy.com/seed-cycling-for-hormonal-balance/. Accessed 22 Oct 2018.

“Menstrual Cycle.” Better Health Channel, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/menstrual-cycle. Accessed 24 Oct 2018.

Phipps WR, Martini MC, Lampe JW, Slavin, JL, Kurzer MS. (1993). Effect of flax seed ingestion on the menstrual cycle. Journal of Clinical Endocrinology & Metabolism. 1993 Nov;77(5):1215 – 1219.

Somwanshi SB, Gaikwad VM, Dhamak KB, Gaware VM. Women’s Health Issue: A Brief Overview on Irregular Menstruation. IJNRD. 2017 May;7(5):2456-4184.

Troina AA, Figueiredo MS, Moura EG, Boaventura GT, Soares LL, Cardozo LFMF, Oliveira E, Lisboa PC, Passos MARF, Passos MCF. Maternal flaxseed diet during lactation alters milk composition and programs the offspring body composition, lipid profile and sexual function. Food and Chemical Toxicology, 2010 Fed;48(2):697-703.

Zaineddin AK, Buck K, Vrieling A, Heinz J., Flesch-Janys D, Linseisen, J, Chang-Claude J. (2012). The association between dietary lignans, phytoestrogen-rich foods, and fiber intake and postmenopausal breast cancer risk: a German case-control study. Nutrition and Cancer. 2012;64(5):652-65.

the eczema body, treatments

let’s get receptive: the relationship between pain and itching

black and brown coat animal on brown trunk
Photo by Flickr on Pexels.com

When I was still in my physical therapy graduate program, we had a lecture on pain and neural pathways, and I stayed after class to ask the professor about the relationship between pain and itching because I noticed my itches sometimes felt like they traveled along a nerve (such a perk of being a PT student, you’ve got to know your nerve branchings!).

I’m reading this book now called Living with Itch by doctors Gil Yosipovitch and Shawn G. Kwatra. This book first got on my radar when I was reading a National Eczema Association post called “Itching for Answers”, and it mentioned Dr. Yosipovitch and talked about how cytokines (one of the molecules secreted by the body’s immune cells that we usually blame for our overactive immune responses), are also located in the nerve cells. The thought is that some of the nerves may have “faulty wiring” and so they are constantly firing and sending up itch signals when there is low to no itchy stimuli.

Anyway, the book goes into detail about various chronic itch-related disorders/diseases as well as the anatomy behind the itch, and it depicts the relationship of pain and itching to be almost inverse. As the book explains, we have a bunch of different sensory receptors on our external body to send information from what we encounter in our environment to our brain. One such receptor type, located in the epidermis layer (the shallow most skin layer) is the C nerve fiber, which relays information about, you got it, pain and itching. These C nerve fibers send the sensation information to a structure called the dorsal root ganglion, and then the info crosses the spinal cord and goes up the opposite side of the lateral spinothalamic tract to get to the thalamus in the brain. There the thalamus sends info about the itch sensation to other parts of the body that link it to our physical, cognitive, and emotional responses. The lateral spinothalamic tract also relays information about pain and temperature, which is important and I’ll get to in a minute.

So what do we know about pain and itching? We know our bodies’ physical response to pain versus itch is very different. With pain, we withdrawal the part of the body that comes in contact with the painful stimuli; step on a nail, you immediately try to pull your foot away. But with an itch, we immediately go to a scratch reflex. The book goes into more detail about why that is, saying that the scratch reflex causes a sort of pain, which effectively masks the itch, and we now know that is precisely because the two stimuli types do share that same lateral spinothalamic tract. And because temperature also can share that tract, this is why using cold on inflamed skin, or taking a hot bath can also mute the itch.

Lastly, the book goes into why chronic pain and chronic itch can be similar. The biggest commonality is that both involve the nerve fibers being overactive, so we perceive the pain/itch to be even more intense (this is called hyper sensitization). And yes, when the sensations are that heightened, like say you are always itchy due to eczema or another condition, something that should be painful like an electric shock, or pouring rubbing alcohol on your scratch wounds (the latter which I’ve done…) might just make you itch more!

The most recent medications/treatments on the market are called biologics (and include names such as Dupixent), and they target the cytokines that give us so much grief. For eczema, those cytokines include interleukins 4 and 13 (IL-4 and IL-13) so far, and they are working to make treatments that target more ILs in the future.

One other takeaway from the book that I thought was relevant is that the epidermis layer, when sufficiently compromised (like after it’s been scratched a lot), can have more sensitive nerve fibers because they are more exposed by the broken skin barrier. So one important treatment in managing eczema is helping to try to repair and protect the skin barrier to subsequently protect the nerve fibers. The book mentions two ways of going about this:

  1. using moisturizers with ceramide in them to help coat the skin barrier as the skin barrier lacks the protein filaggrin*
  2. using moisturizers and cleansers that are more acidic so that they help get the skin back to its normal pH range of about 4-6 (with 1-6 being acidic, 7 being neutral, and 8-14 being alkaline). Note that most soap bars are alkaline.

*A cool way to know if you genetically are lacking filaggrin is to look at your palms. People with crazy amounts of lines are generally lacking filaggrin. I’ll be talking more about filaggrin in a post later this week. Meanwhile look at my lack of filaggrin below!

2018-10-26 13.12.40.jpg

What I am curious about is why then, is it advised by so many dermatologists to take bleach baths? I understand that when diluted, bleach can still help kill a lot of germs on the skin, but if bleach is a pH level around 12 (so pretty basic/alkaline and maybe gets diluted to around 9 when in a bath), it is very far from the desired pH of our skin. If we are adding an element that further changes our skin pH, how does that help our healing? Though I guess if the pH of our skin is higher than 9, bringing it down to 9 with bleach baths would be beneficial then too.

I haven’t searched super thoroughly yet, but the most recent study I found so far indicated that bleach baths with a course of topical steroids was no more effective than just doing the course of topical steroids alone. A review tested a treatment group using bleach baths and mupirocin (a topical antibiotic) versus a control group using normal baths and petroleum jelly and found that the former was more effective, at one month at reducing Staphylococcus aureus (the bad Staph we all know), but again this is not comparing bleach baths in isolation (and the study went on to say that at 3 months there was unchanged frequency of Staph in the treatment group meaning it was still as widespread on the body, though they didn’t test the concentration to see if the quantity of Staph had changed).

Yet another study supported that the topical antibiotics with diluted bleach baths were most efficient at killing Staph, yet also noted all groups (no bleach, bleach with topical antibiotics, etc) had reoccurrence rates of Staph after 4 months. A different review on using diluted bleach talked about how bleach is awesome because it’s a ubiquitous cheap house product that kills bacteria, viruses, and fungi alike and doesn’t cause bacteria to become resistant. However, then it also talks about why the studies using it for infected eczema are lacking, and includes reasons that one might one to avoid using it such as:

  • the amount in a cleaner can vary
  • its strength can degrade over time
  • it can make dermatitis worse
  • it often contains fragrances
  • the studies done didn’t have enough people in them, and
  • there is no consensus on the optimal amount of bleach to use or how frequently use it to effectively stave off future Staph infections.

And again, I’m not sure what the role of a diluted bleach bath would be for those of us avoiding topical steroids/going through withdrawal and not currently on antibiotics.
However, given the pH of bleach alone, and then adding the fact that so many studies mentioned the frequency of Staph reoccurrence, as my skin is going okay right now, I’ll personally be using apple cider vinegar baths more frequently instead.

Amended: This does not mean I no longer take bleach baths, because I still do. I just treat them as a more aggressive maintenance treatment for the management of my skin, and subsequently take them sparingly, but as needed.

 

REFERENCES

Barnes TM, Greive KA. Use of bleach baths for the treatment of infected atopic eczema. Australasian Journal of Dermatology. 2013 Nov; 54(4): 251-258.

Chang MW, Hirschmann JV. Bleach Baths for Atopic Dermatitis. NEJM Journal Watch Dermatology. 2009 Jun 5;(nd).

Crane, Margaret. “Itching for Answers.” National Eczema Association, https://nationaleczema.org/itching-for-answers/. Accessed 23 Oct 2018.

Fritz SA, Camins BC, Eisenstein KA, Fritz JM, Epplin EK, Burnham C Dukes J, Storch GA. Effectiveness of Measures to Eradicate Staphylococcus aureus Carriage in Patients with Community-Associated Skin and Soft Tissue Infections: A Randomized Trial. Infect Control Hosp Epidemiol. 2011 Sep; 32(9): 872-880.

Gonzalez ME, Schaffer JV, Orlow SJ, Gao Z, Li H, Alekseyenko AV, Blaser MJ. Cutaneous microbiome effets of fluticasone proprionate cream and adjunctive bleach baths in childhood atopic dermatitis. J Am Acad Dermatol. 2016 Sep; 75(3): 481-493.e8.

Panther DJ, Jacob SE. The Importance of Acidifucation on Atopic Eczema: An Underexplored Avenue for Treatment. J Clin Med. 2015 May; 4(4):970-978.