Itchy McItcherson: The Follow-up

So, I've been getting a lot of questions lately asking about how my low-nickel eczema diet has been going. I'm happy to report that it's actually going quite well. Initially I was freaking out about all the staple foodstuffs that I would have to eliminate from my diet, but after just a few short weeks of cutting them out, it wasn't so bad after all. 

It's a pretty counter-intuitive diet to what I had been eating for years previously. To recap, I essentially cut out all nuts, all seeds, all whole grains, all beans/legumes (including soy, which is super high in nickel and is in just about everything processed), all canned foods, and all chocolate. I also cut out a few a few fruits and veggies, including raspberries, pineapple, peas, green beans, and green leafy vegetables. Sounds like a lot to cut out, right? So what, exactly, have I been eating? 

For starters, rather than eating whole grain bread, I started to eat English muffins and bagels. That switch ended up being a pretty tasty alternative, as there are so many flavors of bagels, many of which didn't contain anything that I was trying to avoid. To be fair, I didn't really eat all that much bread before starting this diet, so adding in bagels was actually more of a treat than anything. There is a wonderful bagel shop here in Flagstaff called Biff's Bagels, and if I can get my butt out of bed and into town early enough on a weekday, I'm usually able to snag a baker's dozen of day-old bagels at half the price of the fresh ones. They are pre-bagged, which also eliminates me standing there awkwardly counting on my fingers, picking out flavors of the fresh ones. Math is hard for me, especially when put on the spot, so having those 13 bagels already counted out and bagged up is a win-win. 

Eliminating whole grains in general has been a little harder. I loved whole grain pasta, all kinds of rice, quinoa, oatmeal, whole grain cereals, baked goods with whole wheat flours, and the like. Now I eat white rice, white pasta, and I no longer eat cereal because my options are limited to corn flakes and rice Chex, and I'd rather just not. The white grains and flours definitely don't have as tasty of a flavor profile as the whole grains. It seems so unhealthy given that we've been given information about how whole grains are better for our health than overly processed grains, and I don't disagree with that, but if giving up whole grains makes my hands feel better, then I guess it'll have to be worth it. 

I did worry about my bowel health (and overall health in general) and becoming constipated due to a lack of dietary fiber initially, but I started taking a probiotic and I try to eat a lot of fruit throughout the day, and so far that's been okay. Not that you needed to hear about my bowels, but that was something that I worried about in the beginning, seeing as I was cutting out most of my prior sources of dietary fiber. I also started taking a multi-vitamin along with some other vitamins and minerals in an attempt to try to capture the nutrients that I'm missing by cutting so much out of my diet. Truthfully, I could probably just change my diet to capture the appropriate vitamins and minerals, but I'm a lazy person at baseline and for right now, things just need to be easy to ensure my compliance. It helps that all my vitamins are in gummy form as well. 200 calories in fruit snacks every morning? Don't mind if I do! Hahaha! I tell myself that they're nutrient-dense calories, which technically isn't untrue. Historically, vitamins in pill form have also made me super nauseated, and the gummies don't, so that helps with the compliance as well. 

Cutting out nuts and seeds has been a lot harder, as nuts served as a high-protein snack for me. I'm also one of those people who is completely content and truly enjoys eating peanut butter right out of the jar. Out of all the things I've had to give up, peanut butter is probably the one food I miss the most. It's unfortunate that peanuts are one of the nuts with the highest nickel content as well, meaning that I most likely won't ever be able to add them back in, even in small amounts. Nuts and seeds are also trail-snack and road trip staples, so going on long hikes or long drives and packing enough of the right snacks to keep me from bottoming out presented a unique challenge. Pretty much all granola, protein, and trail bars are full of either nuts, seeds, grains, chocolate, or a combination of all four. Delicious, filling, compact...all the things you want in a quick and easy snack; unless, of course, you have diet-related eczema. I started packing really bourgeois snacks...cheeses, salami, packets of pickles and olives, dried/fresh fruit, goldfish crackers. Basically, trail charcuterie. So fancy, but at the same time, a really nice alternative to traditional snacks. It does take a little extra planning, as I don't routinely have all those snacks stashed away for consumption at a moment's notice like I do with granola bars, but it was a simple switch that ended up being okay in the end. I've eaten small amounts of pistachios with no issue, but other than that, I've pretty much avoided all other sources of nuts and seeds, including nut and seed oils. The jury is still out on exactly how much nickel is actually in nut and seed oils, so for now I've been avoiding those as much as possible, just in case. I've been able to find some potato and tortilla chips that are made with either olive or avocado oil, but other than that, most processed snacks have been avoided. You'd think I'd be losing weight since I've had to cut out all these snacks, and at first I did, but I've crept back up to my pre-low-nickel diet weight. Balls. 

Prior to changing my diet, Simon and I had been dabbling in incorporating alternative dairy into our diet. I was using almond milk in just about anything I would use cow's milk. I baked with it, I cooked with it, and I added it to my coffee. We were even making our own almond milk at home in the blender, which is a super easy process, and kept us from buying and throwing away the milk that we didn't get to before it expired. Since I can no longer have nut or seed milks, it's back to cow's milk. I don't drink or eat all that much dairy, but I do crave simple sources of protein, and dairy fits the bill. We also dabbled every now and again in going vegetarian, but with literally all non-meat sources of protein being beans and grains, I've pretty much given up on that idea. So, back to traditional protein sources. It's a little morally defeating, as I struggle with the meat industry and the way the animals are treated. I've touched on this in the past so I won't get into it much here, but hopefully moving forward I can start making better choices at home about where my meat comes from. I can have most meats, but shellfish and certain kinds of seafood have been taken away. You know, in the past I had always noticed that my hands were incredibly itchy when eating peel-and-eat shrimp or crab legs, mostly after touching the shells. I'm wondering if it's the shells that are causing the reaction or the actual seafood itself...could be both, I guess. In any case, I haven't eaten shellfish since back in November. I've had a few different types of ocean fish and have been fine with those. Canned fish (anything canned, really) is completely off the menu. 

I haven't been super strict with this diet, and because of that I've had some obvious diet related flare-ups, but nothing like I had before I started being more selective about what I could and couldn't eat. I also notice that my flare-ups are smaller and tend to heal faster when I'm following my dietary restrictions. I try to keep my diet pretty consistent these days, but I leave room for experimentation and trial and error. There has been some debate about whether or not the nickel sensitivity is a cumulative sensitivity (how much in a day is too much), or if it's more related the amount of nickel in an individual item. For instance, I've been able to sporadically eat chocolate in small amounts. Unfortunately, the chocolate that I've been eating is not the Dove dark chocolate that I prefer, but rather it's been chocolate icing on donuts, or chocolate flavored things, and how much chocolate is even in that, really? I've had chocolate croissants with no issue, but again, what is the concentration of dark chocolate in those? With regard to chocolate, it's the amount of actual cocoa that's in the chocolate that I react to, so the more diluted the cocoa is with other additives, the less likely I am to react. But I don't really like diluted chocolates, so I just haven't been eating them. Thankfully I haven't been missing it all that much; I was really concerned in the beginning that excluding chocolate from my list of indulgences was going to be really hard. Instead of drinking mochas, I've switched to lattes with honey and cinnamon. They're delightful. I love cinnamon, and that little bit of sweetness from the honey is just icing on the cake. So that was an easy transition. I really, really miss the dark chocolate peanut butter cups from Trader Joe's. I haven't had a single one, not even a little nibble, since I started this diet. The combination of dark chocolate and peanut butter has high potential for disaster, so I've reluctantly avoided them all together. At Christmas time my friend Sonia made us Oreo truffles, and I had a little bite of one and passed the rest of it to Simon. It was so good, and that little taste was all I needed. Again, there's that question of how much cocoa is in Oreos? Probably not all that much, but indulging has not been without its risks. 

Recently I had a vegan dish at a friend's house that was full of lentils and nut cheese, and I paid for that one with open wounds on my hands a day later. No bueno. In that same span of time I had also had two pieces of Dove chocolate...one was milk chocolate with caramel, and the other was dark chocolate with white chocolate swirls. I had also worked a shift at the hospital during that two-day span, then slept about 3 hours afterwards and packed up the van for a camping trip. So...poor dietary choices plus work plus lack of sleep equals a recipe for disaster. Narrowing down which was the biggest contributor to that particular flare-up is difficult and likely multi-factorial, so I've decided no more experimentation on that level. The nuts, the legumes, the chocolate...all are back on the "no" list. It's been hard eating at other people's houses, because so many of my friends are fantastic cooks, and while I would never ask them to tailor their cooking to my specific restrictions, I've typically been able to pick around the things I shouldn't have. And again, there's a lot of trial and error with this diet, and I like seizing the opportunity to try different things to see how/if I will react. 

I've also come to realize that potentially more than anything, my stress level definitely exacerbates the eczema, in addition to but partly unrelated to what I'm eating. When I'm at work, I try to eat the same tried-and-true non-reactive things every night with little to no deviation: grapes, strawberries, clementines, hard-boiled eggs, cottage cheese, avocado/olive oil potato chips, and some sort of hot meal consisting of a meat, a veggie, and either white rice or pasta. I bring my own food and I am very selective if I go to the cafeteria for a snack. Despite all that, even when I behave as much as possible with my diet, I always have a flare-up when I'm working; the more shifts in a row I work, the worse the flare-up will be. I can sometimes get away with one shift in a row with no issues, but after two I start noticing itchy spots, and after three or four shifts there's definitely open cracks, blisters, and intense pain. It absolutely could be due to the excessive amount of hand washing and hand sanitizer use, but I know the stress is definitely a contributor. I won't get into it much here, but I'm planning on making some career changes that will hopefully help with my stress level at work. More on that in a later blog. 

So many products: CeraVe daily lotion frequently applied to my hands throughout the day, Cetaphil Gentle Skin Cleanser for handwashing, CeraVe Moisturizing Cream on my hands at night, CeraVe Hydrating cream-to-foam cleanser as a body wash, and Vanicream as an all-over moisturizer after the shower.

I've made some pretty major changes to my personal care regimen as well, and that seems to have helped. One of the biggest things that's made a difference is when I feel the itching or a flare-up coming on related to a personal care product, I'll run my hands under cold water and wash with one of my dermatologic soaps and follow up with a moisturizing lotion. It sounds kind of silly, but it seems to cool down the flare-up. Most of the time it works, but not always. I had been using a few different Monat shampoos, conditioners, and facial cleansers/scrubs, and I noticed that after using some of them, I'd exit the shower with super itchy hands, so I've gotten rid of those. There are a few I can still use, but I'm slowly using them up with the intention of switching to Beauty Counter products, which have not yet produced a single itch. I think overall the Beauty Counter products have less reactive ingredients than the Monat products, at least that's been my experience so far. There's an app called EWG Healthy Living that I've been using to help with my decision-making when it comes to personal products, and the Beauty Counter products are consistently rated lowest when it comes to "chemicals of concern." I switched my facial regimen from Monat to Beauty Counter as well, and that seems to have made a big difference for my hands, not to mention my face, which feels so soft these days. I'm currently in the process of switching all of my personal care products to Beauty Counter; more on that in a later blog. I wear gloves when I'm doing the dishes, bathing the dog, or using any sort of cleaning products, and that seems to help as well. 

In addition to changes to my diet and personal care regimen, I started taking Singulair in the morning and Xyzal (a 24-hour antihistamine) at night, and I think they're making quite the difference. I definitely notice if I miss a dose, particularly of the Singulair. I'm hoping that maybe with this regimen my seasonal allergies will be better this year as well, but we'll see; it's too early to tell yet. The true test will be once the ponderosas start dropping their pollen and the aspens start budding, which is always a problematic time for me.

So, kind of a long update, but there are so many factors involved with managing an auto-immune disorder that I wanted to touch on all of them and share what's worked, and what hasn't. Overall these past few months have been some of the best months I've had with regard to my flare-ups, and I'm super stoked about that. All of the changes I've made, whether it was adding something new or subtracting something I loved, have absolutely been worth it. I know there are probably more things that I could be doing, but for now, this seems to be working without affecting my daily life all that much. I've made peace with the fact that I might never be able to eat peanut butter again, but it's been so refreshing to look at my hands most days and not see a single blister, a single red spot, or an open wound. To think that I had been living like that for over a decade is mind boggling, but it's nice to know that I don't have to anymore.