My great Italian bread/pasta experiment

I've been gluten-free for about 8 years now. What that means in reality is that 99% of the time I eat only foods that are gluten-free, with about 1% of the time, having some sort of exposure to wheat-based grains. I don't mean that I have "cheat days" but I'll consume something at a restaurant that may not be completely wheat/gluten-free. Not breads, pastas, nor pastries... those have always been off-limits.

But that all changed when my husband and I decided to honeymoon in Italy. I knew that they used a different species of wheat in Europe, and had heard that those with gluten/wheat sensitivities often can tolerate bread and pasta way better there than in North America.

I was intrigued and excited to eat real bread and pasta for the first time in almost a decade. My goal was to eat and drink my way through Italy and see what happened. I was going to eat real baguette bread; I was going to enjoy a pastry at a cafe; Focaccia in a market. Hell, maybe even pizza!

So I did. I ate it all and for the most part I loved it all, but there were lessons that I learned with each meal:

First, not every restaurant or venue gets their flour from Italy. I made an incorrect assumption that our Mediterranean cruise would be serving local foods. I soon found out that even their beef came from Chicago (which induced a huge "WTF?!?" moment for me). Pasta, I learned, had to be labeled specifically as "durum wheat" pasta. But the breads and pizza still left me bloated, gassy... my insides were not happy even if my taste buds were.

Off the boat, food was much easier. I wasn't having reactions from independent/family run restaurants. Anything that was non-touristy seemed to be fantastic, and my gut agreed. I was able to eat focaccia in Venazza, pasta in Taormina and Genoa, and croissants in Florence with no issues. It was glorious. I was able to enjoy heavy starches that didn't feel so heavy.

I felt like I had an excuse to be indulgent; and perhaps I did. But that feeling wears out after a while. By the end of our 2-week vacation I was craving protein and vegetables. I was craving leafy salads and steamed broccoli drenched in olive oil. Not to mention that my waistline definitely widened being on a predominately carbohydrate-based diet.

They were gloriously happy-making meals for the time being, but it wasn't something that I would be able to continue. The body - my body - can only take so much. The challenge now is switching back. Getting my body back, reducing my carb and sugar cravings, and regulating my blood sugar.

The Aftermath of my Gluten Experiment

The last croissant I had was at the airport before we left Europe. It was everything I had hoped it would be, until I stopped to pay attention to my body. All of a sudden I felt anxious, my heart beating fast. What was going on? I realized it was my blood sugar. Having only had a croissant, my heart was racing and I felt like I needed a run. I knew this was a pattern I'd have to get out of. This spike in blood sugar was uncomfortable, but all too common.

Secondly, the residual carb cravings after having come back. I almost forgot how strong they could be! Telling me to go bake a batch of cookies, or eat more of that sunflower seed bread, or, how about a third serving of rice? It's so hard to battle that voice; even more so when you're feeling exhausted.

Thirdly, by the end of the two weeks, and more so in the two weeks upon our return, my skin broke out like crazy! Not just facial acne, but eczema!

What gets me through this part is knowing how good I can feel on a low-carb diet. My tastebuds and brain were spoiled in Italy. We deserve it! To enjoy the food of another country and culture is an experience not to be taken for granted, but for my own personal health, it's not a lifestyle I can thrive on long-term.

I'm so happy I took a chance (with the help of probiotics and digestive enzymes) eating Italian wheat products, but I'm even happier to be home so that I can stuff my face with veggies and proteins again.

Treating skin conditions: Part 2 - From the inside, out

Although soothing and cleansing your skin with creams and oils can make a huge difference in skin healing, the root cause of many inflammatory skin conditions comes from inside the body.

The challenge is in figuring out which part of your system has been compromised, as there are multiple reasons why we break out in acne, psoriasis, or eczema. Although each one of these disorders is unique, they all share the common thread of being inflammatory in nature, and typically arising from an internal disorder.

Common culprits of inflammatory skin disorders:

• Food sensitivities: IgG immune system reactions
• Stress, leading to chronically abnormal cortisol levels
• Hormonal fluctuations, as with estrogen and testosterone
• Dietary nutrient deficiencies or insufficiencies, such as, essential fatty acids, vitamin A, vitamin B5, vitamin D, and zinc.
• Compromised or delayed liver detoxification pathways leading to increased toxin and/or metabolite burden.
• Oxidative damage from an imbalance in free radical production vs antioxidant action.
• Insulin resistance
• Inflammatory bowel disorders: causes a barrier disruption and give substances like toxins, allergens, and microbes greater access to your system. 
• An immune system imbalance, promoting a greater TH2 response and suppressing TH1 responses --> more serum IgE --> "allergic diseases" including eczema and asthma.

The detective work can be frustrating for a lot of people. A medical doctor can give you a steroid cream and they work really well at suppressing skin inflammation. Lesions will easily disappear in a matter of hours or days. But once you stop using them, many eczema sufferers find their lesions come right back, just as fast. So, by needing to take weeks, or even months, to get to the root cause of the problem without the use of steroid creams, it can be frustrating for many. 

It is also important to note that steroid creams can cause skin thinning, and therefore should be avoided on or around delicate skin (like around the eyes).

The bright side is that it can get better. A lot better. Treatment requires patience but is well worth it when you realize that you're not only fixing your skin, but you're creating a healthier body inside as well. 

For example, you might resolve skin lesions by changing the diet and improving the gut microbiome. In treating the gut as the root cause, we also improve digestion and can lessen symptoms of IBS like gas and bloating. 

As another example, in treating the immune system, and promoting TH1 responses with substances such as echinacea, reishi mushroom, plant sterols, and others, we could potentially see a decrease in concurrent asthma or sinusitis symptoms. 

There are multiple ways to treat skin conditions internally, but figuring out the root cause and correcting it is a process. The good news is that we are not limited only to the quick-fix of steroid creams - though they can be helpful at times! 

What can you expect when you see a naturopathic doctor (ND)?

An initial appointment is often 60-90 minutes in order to get a full picture of your health and health history. A physical exam may be warranted, at least to visualize any current lesions. In some cases, your ND may feel it necessary (or will give you the option) of having tests run to rule out specific causes. 

Examples of tests that may be run:

• Blood glucose/sugar levels, testing fasting blood glucose, HbA1C, and fasting blood insulin
• IgG Food Sensitivity test (often done as a finger prick or blood test): Can outline each specific food that your immune system is reacting to. 
• 4-point cortisol test to monitor your cortisol levels throughout the day
• A blood test for the hormones such as FSH, LH, and androgens (to help rule out PCOS and androgen-related acne)

Otherwise, treatment is often started right away based on your intake information and physical exam. This may include:

• Dietary changes and modifying eating habits
• Modifying the gut microbiome with probiotics or probiotic foods to improve immune responses
• Botanicals and medicinal mushrooms to promote TH1 responses
• Antioxidant, vitamin and nutrient supplementation
• Working on stress management 
• Avoiding exposure to toxins and irritants
• Promoting phase 1 and phase 2 liver detoxification pathways with either food or supplementation

(Be sure to seek individualized advice and treatment from a licensed naturopathic doctor before starting any supplement or major dietary change. The above is for educational purposes only)

Treating skin conditions: Part 1 - Topical (lotion/cream) help

Troublesome skin has been a huge part of my life. My mom will tell baby stories of me with more than the average diaper rash: angry, red eczema covering huge portions of my body. She changed detergents, could only buy very specific brands of wipes and diapers, using "hypoallergenic" lotions and creams... but everything made my skin angry. I grew up with eczema and dry skin in general; always patchy, but it always came back.

The most troublesome spot was the inside of my elbows, and it was awful seeing as how everyone in gym class and at school in general could see it. Sometimes it would move to the backs of my hands and knuckles, to my stomach, under my arms. It was unrelenting.

Steroid creams like hydrocortisone definitely helped. Of course they should! They suppress inflammation. So after 2 days the patches would be gone, but just a few days later and we'd be starting all over again with itchiness, redness, dry, scaly and patchy skin, and then it was back to the steroids.

This is something I see often in practice and the problem is how we treat the skin. We think because skin is on the "outside" that we should treat skin conditions solely with topical treatments, but this isn't the case. In fact, more than 90% of the cases of acne and eczema that come into the clinic are not due to any external irritant. These eruptions of inflammation are telling us that something is wrong on the INSIDE (I'll talk more about this next week in "Part 2").

Of course, changing your detergent and body products can still have a big impact, and that's in part because some of these chemicals and substances can be absorbed through the skin and get into our bodies (and blood streams). Sometimes we forget that all of these things are linked: what we expose our bodies to (internally, like food, and externally, such as body products), can affect our hormones and elicit immune responses like inflammation.

What should you avoid in skin care products?

• I tend to toss away any product that has a high amount of alcohol in it. Alcohol is drying and on eczema, it can cause burning and stinging. Eczema is already a dry skin condition, no need to dry things out even more. 
• Avoid products that have any type of alcohol listed in the first 5 ingredients. This is more common in lotions, as opposed to creams. 
• Fragrance and Parfum/parfumes: these tend to be chemical irritants. Look out for them in body products and try to pick fragrance-free products, or those that only contain natural essential oils 
• Side note on essential oils: There are some that can still be irritating for skin, especially in concentrated forms. Avoid oils that have a "pine" scent as these can be more irritating and astringent. 
• Parabens ( including methylparaben, ethylparaben, propylparaben, and butylparaben: These are known hormone disruptors. 
• Propylene glycol: can be a skin irritant
• Triclosan: a skin irritant that also may disrupt hormones

Growing up with this type of inflammation, it's an understatement to say that I've tried out a LOT of products. I found I had to rotate my moisturizers on a continual basis. From all of that experimenting I have come to the conclusion that: 

Products with the most "natural" ingredients and oils seem to give way better results than those that are "dermatologist recommended" or "pharmaceutically designed" --> Even if it says "hypoallergenic" on the label. 

All the Cetaphil, Aveeno, and Vaseline in the world couldn't help me and instead my skin just burned and itched even more. 

Look to the following helpful ingredients either on their own or in combination:

• Shea butter
• Cocoa butter
• Vitamin E oil
• Aloe vera
• Avocado oil
• Olive oil
• Coconut oil
• Vegetable Glycerin (especially for soaps - I've gone back to Natural bar soaps!)
• Avena sativa (oat) extracts

My favourite products at the moment are Scentuals Scent-free Hand & Body Lotion, and Aleva's Daily Soothing Moisturizer (pictured below):

For my face and hands, I primarily use oils. This is also a great added treatment for eczema lesions. As often as you can, apply small amounts of coconut oil, shea butter, vitamin E oil to damaged and itching skin. Oftentimes I'll even incorporate a natural diaper rash cream (something with Zinc Oxide and Calendula) for skin healing and the zinc to decrease itching. 

These ingredients are meant to heal skin, provide anti-inflammatory support, and nourish damaged tissue. While we nourish our skin from the outside, we must treat it on the inside (see Part 2 next week).

The goal is to be consistent, and often I'll have patients apply these products as often as they can throughout the day (at least twice daily, but up to 4 times can give better results).

For an individualized plan and prescribing, I suggest seeing a licensed naturopathic doctor as not all of these options will be right for everyone (especially in the case of allergies or sensitivities).

In "Part 2" of Treating Skin Conditions, we'll review treating the body from the inside out for both acne and eczema. Check in next week!