The recent American College of Allergy, Asthma and Immunology (ACAAI) 2023 Annual Scientific Meeting in San Diego, California sparked a conversation about the need for nutritional support for patients with skin conditions such as atopic dermatitis. Atoosa Kourosh, MD, MPH, is a board-certified pediatrician and allergy and immunology specialist who oversees a holistic clinic in Southlake, Texas. She spoke to Dermatology times on opportunities for allergists and dermatologists to work together, her approach to cases and patient resources.
Dermatology times: Can you discuss the highlights of your ACAAI? presentation?
Kourosh: We are actually very pleased that the ACAAI, the American College of Asthma Allergy and Immunology, is showing interest in offering integrative medicine in our annual meeting program. I think this is a response to the desire of the community of allergists who want to know more about integrative medicine because they know their patients are using it and they are exploring integrative and holistic pathways. So our feeling is that they should be there and agree with that. Our committee presents a symposium on what the allergist needs to know about various integrative therapies, and I cover special diets. I’m probably not the only doctor who gets a lot of questions about special diets; I’m sure primary care physicians get other allergists, dermatologists, rheumatologists, GI doctors and many specialties asking questions from their patients about special diets. And there is certainly a lot of direct marketing being done by proponents of special diets and those who have programs to sell.
The most important thing about my presentation is that it’s about what these diets claim to do, or claim they will do, and it’s about the actual evidence we have, if any: the evidence that supports the possible risks of participating or sheds light. with these diets. One of the things I always emphasize in my practice, which is a precision medicine practice tailored to the individual, is that while we have guidelines and we do research, recommendations – especially nutritional recommendations – need to be individualized to the patient and the specific needs of the patient, and especially in case of allergies. We have a long history of doing that with our patients with food allergies and helping them avoid their food allergens, but I think these special diets that are being marketed go beyond that and make health recommendations and health claims that they can either reverse. prevent illness or disease. So we’re going to investigate what evidence exists for this.
Dermatology times: How do you suggest a doctor talk to his patient who comes in wanting to try a diet that may not be recommended or beneficial?
Kourosh: One of the main things that would appeal to a patient when you talk to them about whether or not to adopt a diet is to consider the risk-benefit ratio and the cost-effectiveness of implementing that diet, because many of these diets will be expensive are. They will either require some form of supplemental nutrition or require the patient to shop for groceries in a very specific way. So taking the risks and benefits into account is one of the ways to approach that.
The other is to approach this: “Let’s try it temporarily if you’re really excited about trying this diet, and then rate your results.” It shouldn’t be approached as a lifelong thing when we’re trying to find out if it works at all. So, for example, if a patient is trying to influence their autoimmune disease by following a specific diet, it would be important to have the current markers of that autoimmune disease in time and a possible endpoint to measure the impact . It is often very difficult for GPs to respond to this if they only have a few minutes to talk to their patient. Referring patients to nutritional support can be one way to help with this, especially those who have access to nutritional advice. Sometimes insurance will cover nutritional support visits a few times a year, especially if a doctor feels it is necessary.
Another thing is to present from the patient’s perspective. What they hope to achieve is that a diet is the right diet to achieve those goals. Because, for example, patients came to me and said that I am trying this diet mainly to lose weight, but I hope it will help me with my allergies, autoimmune diseases, eczema, add whatever they want. we are trying to achieve. I talk to them about how that diet is designed and whether they are nutritionally able to handle that drastic change in diet.
The other thing I’ve talked to patients about is that there are two approaches to changing the diet: one is a gradual, step-by-step approach where things are changed gradually, and the other is kind of cold turkey, a kind of change that you can change at once. where everything has changed at once. And the problem with that is that sometimes our digestive system can’t keep up with that level of drastic change. We more or less adapt to digesting the food we eat regularly. For example, if someone switches from eating primarily a starch-based processed food diet to a completely plant-based, raw food diet, he/she may experience some digestive problems because it takes a while for the digestive system to learn and adapt and be able to eat . to digest those fruits and vegetables, even though they are super healthy. It is not that the diet is inherently unhealthy, but that the patient may need time to adjust. I definitely discuss that with my patients and talk to them about methods to gradually make even positive dietary changes.
There are certain things that patients can do cold turkey, like cutting out processed sugar, but again, I talk to them about how if they rely on that processed sugar for an energy boost, they may experience a feeling of fatigue or energy. loss, and to adjust accordingly. I also never start a patient on a diet change, even if I feel it is the right diet for him or her, without some kind of introductory time – a time of learning. I also advise them to start on Friday so that they have the weekend. They have two days off at the weekend to sort things out and prepare for the following week. Because the life disruption that comes from attempting to change one’s diet often creates so much stress in the patient’s life that it negates the benefits of the positive changes they are trying to make, even with a balanced, healthy diet.
Dermatology times: What resources would you recommend for physicians who want to learn more about integrating nutrition or diet into the support of their patients?
Kourosh: There are some resources from the American Academy of Pediatrics. They have a toolkit on healthy weight for children, and all of these recommendations are very evidence-based recommendations. There are also resources on the American Dietetic Association website about macros, what kind of calories, what kind of protein needs, kind of carbohydrate and fat needs are found there. And then I would try sources that show a scientific basis, as if they were actually put together at this point. Most medical societies don’t have much, but some do, like the Society for Obesity Medicine. Such associations have focused a lot on diets, such as weight loss diets.
As far as sources for general nutritional advice on dieting, I would say there are a few publications that try to educate the public in general about dieting and are not based on a corporate agenda. I would look into that. The American Academy of Pediatrics is what I primarily use because before I became an allergist, I was a pediatrician and I worked very, very hard on childhood obesity prevention, and I use those resources and I tend to rely back on them. I also really look at the literature because a lot of these diets have been reviewed. The National Institutes of Health has a section or division on complementary and integrative medicine, and they’re not just focusing on integrative therapies and supplementation anymore either. or supplements, but also towards changes in diet.
Dermatology times: Do you have any closing thoughts on diet and nutrition?
Kourosh: I would encourage people not to make any drastic changes to their diet without consulting a nutritionist or dietitian or their doctor because people often don’t realize that they may be going down the wrong path and also that their system may need some changes or some need support if they are going to do that.
I would recommend making any drastic dietary changes under medical supervision, and while many of their publications and online resources are aimed at medical professionals, the Institute for Functional Medicine also has many resources for patient education, especially in the area of healthy eating. , and around the types of diets that are often promoted because of medical or health-related issues. So they benefit greatly from a heart-healthy diet. They have many autoimmune diseases. That’s why I encourage people to visit the Institute for Functional Medicine’s website, as many of these resources have been extensively researched and compiled before being compiled into a series of blog posts and courses, some of which are even available if you’re not a medical professional .