Judy Converse, MPH RD LDN is the founder of Nutrition Care, a licensed nutritionist, a registered dietitian who has a master’s degree in public health nutrition and a bachelor’s degree in food science and human nutrition. She has also testified for safer vaccines and consulted with industry partners on specialized formulas for infants and children with inflammatory conditions. Her books include:
This is a 4-topic series focused on nutrition for babies and toddlers with eczema. It was originally spanning 7 posts, and combined to 3 longer informative posts.
- What’s Reliable Nutrition Information
- Newborn Nutrition – Just Milk, but Complicated
- Breastfeeding – Impact on Eczema Babies & Infant Reflux
Starting with the Fundamentals – What’s Reliable Nutrition Information?
MarcieMom: Judy, thank you so much for helping with this series, it’s very relevant for children with eczema and parents would be eager to learn more on nutrition (don’t we all think of what to feed our kids!). We will work through 4 different topics for this series, but before that let’s tackle something more fundamental.
Nutritional Study for Eczema
Nutrition advice is seldom given by dermatologists or pediatricians and understandably so since doctors are (i) not trained in nutrition and (ii) always careful not to advice beyond what’s been clinical proven. Are there then insufficient studies on nutrition’s impact on health and eczema? If so, can you explain the difficulties with conducting a large scale nutritional impact study? (I’ve googled eczema and nutrition study and could only find studies relating to pregnancy diet, fish oil and probiotics, and even that seem inconclusive.)
Judy: Nutrition is hardly a new science – It has been around as a science for over a century. But it has not been part of most physicians’ training for decades. So we have a huge gap in the knowledge base of physicians. Some data show pediatricians know little more than parents do about nutrition. To get reliable information, at least here in the US, parents may have to turn to a naturopathic doctor, a dietitian specializing in pediatrics, or find a physician who happens to have decided to become knowledgeable about nutrition. You would look for a masters degree in a nutrition science from an accredited university, in addition to the MD degree, in that case.
You would look for a masters degree in a nutrition science from an accredited university, in addition to the MD degree
As for data on nutrition and health – absolutely, the impact is profound. This is why there are nutrition program initiatives in UNICEF, the World Health Organization (WHO), and US government. You truly are what you eat. You grew in the womb from what your mom ate and rearranged into you! And in infancy and childhood, nothing is more predictive of healthy outcomes than strong nutrition status.
You truly are what you eat.
Challenges in Eczema Nutrition Studies
Regarding eczema, I have seen published data on this. Elimination diets, probiotics, fish oils, and other supplements are promising and frequently helpful. This may be a little harder to find since much of what gets published in medical journals is about pharmaceuticals, not natural substances.
Pharmaceuticals get researched much more, because they are patentable and thus very profitable. Nutrients and foods are neither, so there is less interest in studying these in any medical context.
Studies are hard to do on this topic because it’s hard to control the test variable – mainly, foods eaten. There are a few methods of assessing food intakes in a research context, all of which are time consuming and interviewer dependent. And, people lie or forget when it comes to reporting what they eat. They just do. You then also need well controlled subjects, e.g., 3000 kids age 4-5 years old who all have the same growth status at the start of the study, no bowel or feeding issues, and so on. Lastly there simply is no controlling the biggest wild card: What is in each child’s gut for biome (microbe population), which has much to do with how they digest/absorb food, and how inflammatory a food may become. Lots of moving parts, for something that cannot create a profitable product. This is why these studies don’t get done.
Lots of moving parts, for something that cannot create a profitable product.
Reliability of Nutrition Information on Web
Supposing that doctors won’t be able to advice on nutrition and should patients not have access to nutritionist and turn to the internet for nutrition information, what is your advice on how parents can discern which nutrition advice they ought to read and adopt?(Particularly given that there always seem to be a nutritious food that suddenly receives all the magazines’ attention or different website will go all out to propose that their type of supplement works wonders.)
Judy: Assess the source of the info, and look for credentials. University degrees, clinical experience, peer review authorship, lecture experience at respected venues, and licensure demonstrate expected level of expertise. Nutritionists in the US are licensed by state, and have to complete ongoing credit hours, pre-approved by the licensure boards, to keep their credentials. Licensure is not the same as a certificate, which can mean anything, from attending an afternoon lecture to taking unaccredited correspondence courses with no professional oversight. People often identify themselves as “nutritionists” but may have little training.
Assess the source of the info, and look for credentials. University degrees, clinical experience, peer review authorship, lecture experience at respected venues, and licensure demonstrate expected level of expertise.
Look also at whether or not the info you are reading is from a person who simply writes a lot, or is actually in practice. Many dietitians choose careers in communications or media, and never actually see patients once they leave school. They don’t have hands on experience. For tough questions, case experience is invaluable. It’s where scientific inquiry incubates, when it comes to medicine.
Ultimately, if you’re really motivated, you may find that you need to delve into the medical literature yourself. This is unbelievably easy now with the web. I’ve met many parents in my practice who have become laudable experts on certain facets of nutritional biochemistry, in their quests to solve their children’s health challenges. I am grateful to learn new things all the time from the families I work with.
Supplement Trial DIY Style – What to Take Note
MarcieMom: Also suppose a parent decides to try a certain food or supplement for their child, what would be the time frame to look at to determine if it is making the child healthier (or improving his eczema) and what signs should the parent look out for to determine that the child is better or worse? (for instance, weight/height or skin or bowel or hair or teeth or alertness?)
Judy: First, parents need to know if a supplement or food is the appropriate measure. That is what I help parents sort out with an initial nutrition assessment. That’s best – you get a baseline, identify the problems, and choose the tools to fix the problems. But in reality, parents do tinker with supplements. I discuss this dilemma in both my books. You can waste a lot of time and money here, if you don’t approach this more methodically. There are tables and charts in my books to help parents sort out what might be the right next steps, with regard to using supplements. I explain dosing, time frames, and more.
You get a baseline, identify the problems, and choose the tools to fix the problems.
Kids Nutrition – A Process, not a Pill
Next, nutrition is a process, not a pill. If a child has entrenched eczema and underweight, there is probably not going to be a single answer to that, and it is probably not going to go away overnight. Unlike medications, nutrition aims to solve the problem from a deeper level and help the body heal itself. I would look at several factors in the assessment process to sort and prioritize what is
going wrong. Different problems respond at different paces; some supplements work fast; others, like fish oils, can take weeks to calm and restore the skin. Nutrition tools are only as good as the weakest piece. They all work together. If you only fix one problem and overlook others, that child will continue to do poorly, even if you’ve picked a great supplement to try.
That said, once I have the pieces in place for an initial plan, I expect a child to respond fairly quickly. Positive changes should emerge within the first month.
MarcieMom: Thanks Judy, and your explanation sheds light into why there sometimes is a disparity between what the supplements say they will achieve and why it sometimes do and don’t.
