Nickel Allergy From Food? A Conversation With Expert Dr. Matthew Zirwas, MD

Watch or read the transcript of my interview with Dr. Matthew Zirwas, MD about systemic contact dermatitis to nickel and systemic nickel allergy as well as our book, “The Low Nickel Diet Cookbook & Guide”. He also wrote a letter/article you can take to your healthcare practitioner about this allergy if you need to.

Dr. Zirwas: “Like this has all been very well worked out and proven. This is the most concretely, absolutely proven, direct cause of an inflammatory diet that exists. And I mentioned this earlier. It always amazed me that nobody knows about this. But the reason nobody knows about it is until your cookbook, we had no idea what to tell people. So it was kind of like, well, this is probably what is making you feel so sick, but I don't have any advice for you. Good luck. See if you can figure it out on your own, which I kind of know is your story, but you actually did figure it out, which is how we got the cookbook. Now that we've got an answer for people, which, hey, go get this cookbook and follow this, that's what has me so excited.

Because we've got the data. We know this is a big problem. We just never had a solution until you gave us one. So thank you. “

Laura: “Matthew Zirwas, MD. Is an american board of dermatology certified physician. He is a nationally known expert who has been specializing in contact dermatitis puritis atopic dermatitis, and seborrheic dermatitis for the last 20 years. In addition to the practical experience that comes from taking care of challenging patients, he has published over 195 peer reviewed articles, been an investigator on over 80 clinical trials, coauthored the 7th edition of Fisher's Contact Dermatitis, and has given over 200 national continuing medical education lectures to his peers. He was gracious enough to lend his expertise in systemic nickel allergy by contributing to my cookbook and guide, the Low Nickel Diet, to help people make this diet easier to understand and to implement. So thank you very much for being here. Dr. Zirwas, we have a bunch of questions to ask you. How are you doing today?

Dr. Zirwas: “I am doing great. And Laura, I am so excited to be here. I'm so excited for people to start to understand just how common this is and what a huge difference it can make in their lives.”

Laura: “Yeah, great. Yeah, I went to a bunch of different online communities, some on Facebook and some in Reddit, and I let them ask as many questions as they wanted. We got over 50 awesome questions, but I'm not going to ask you all of them here, but I did narrow them down to about nine topics. So we'll try to keep it under control for you today. But there's a lot of interest, there's a lot of questions out there, so I'm really glad that we're working on bringing these answers to people. “

Dr. Zirwas: “It still amazes me to this day that with all of the chatter out there in the world about anti inflammatory diets and the whole 30 and autoimmune protocol and all of that stuff, which really don't have that much evidence behind them, that the one thing that we have just rock solid decades of evidence that is a huge driver of systemic inflammation nobody has ever heard of. I don't care who the influencer is. How? How big of an expert they are on gut health or whatever else. Nobody has heard of this. Nobody's aware of it. And to get started and the number of people who are going to get better because of your cookbook is just so exciting. And I truly hope that the 5 million people in America at least, who have systemic nation because of nickel and their diet, that even if you were able to help 1% of them, that's 50,000 people. Right. Let alone if we can get the word out there to where you literally could be helping millions of people. And it is just so exciting. “

Laura: “Yeah. It's incredible. Alright, so why don't we just start with a general explanation of what this condition is?”

Dr. Zirwas: “Yes. So it is a really fascinating thing. So nickel is a mineral just like iron or. Calcium or magnesium or zinc. And just like those minerals, there are certain foods that are high in nickel consistently. But unlike those minerals, there are a ton of people. So 20% of the population, their immune system reacts to nickel, because there is nickel in food. If you are one of those 20% whose immune system next to nickel, if you happen to eat a diet that's high in nickel, it's going to cause inflammation in your body.

Now, it varies a ton from person to person in terms of how much nickel you need to eat. And it's not like, oh, my God, if you eat any. My experience is that for most people, there's a threshold, and it's very different from person to person. But if you can get below your threshold, the inflammation in your body is going to drop dramatically, and it's going to make you feel better.

And that is the basic of it. It's this mineral that is not harmful if you're not allergic to nickel, it's not toxic or harmful in any way, shape or form. But if you're allergic to nickel and if you eat enough of it, it is going to activate your immune system. And we've got 50 years of data proving this, of people experimenting on it, intentionally giving people high nickel diets, intentionally putting them on low nickel diets, seeing how much nickel it takes, seeing how it affects. We have so much data on all of this. And what would you say are the most common symptoms that people have? Yeah, fantastic question. We know for certain that some of the very common manifestations are getting eczema on your hands, and in particular, it's often. called dyshidrotic eczema. But basically it's like little tiny blisters can sometimes be big blisters, but in most people, it's little tiny blisters. They look like little, they're like the size of a grain of rice or the size of a grain of sand. Itch like crazy. And then they pop, a little bit of fluid comes out, then they stop itching after they pop, and then they hurt like crazy. And a lot of people will some people get a bunch all at once, and then they cycle through, and after about two weeks, they heal up and say, okay, good, it's over. And then a whole bunch more start. And it's just this constant, this other people, they're getting ten blisters a day, and ten blisters are healing a day, and ten new ones are starting a day. So it's just bad, the same amount of bad all the time. That's the best known. The other common things that we see in the skin, and it's mainly dermatologists who have done the work around this.

So that's why we know so much about the skin manifestations, itchy bumps on your elbows. This part of your elbow is another very common skin manifestation of it. And then itchy bumps kind of scattered or anywhere all over your body. Can't even be hives or things like that.

Those are the classic things that we've known about for decades as dermatologists have studied this. And just one thing for people why dermatologists? Right? Why would different time? Because we're very used to dealing with nickel allergy when nickel touches your skin. So if nickel touches your skin, especially from an earring or a belt buckle, you'll get a rash.

If your immune system reacts to nickel and the metal item, the earring of the jewelry, releases enough nickel, you'll get a rash right where it touches your skin. So that's why dermatologists are very tuned into nickel allergy. And the guy who probably first started to figure this out realized that, jeez in my patients who are getting rashes on their earlobes, they seem to get rashes on their hands.

That was a guy, back in, I believe, Denmark in the 70s was the guy who started all of this. But then more recently, the things we have learned so people with irritable bowel symptoms, so bloating, abdominal pain, diarrhea, just general gastrointestinal distress, have a very high rate of nickel sensitivity and can get better whenever they go on a low nickel diet.

We've definitely seen, at least I have seen patients with other things like chronic fatigue, fibromyalgia, chronic migraine headaches, arthritis, things like that, that we've also seen, I've seen get better whenever we diagnose nickel and get people off of it. Now, we don't know that could be make one person in 5000 who has migraines, it's nickel.

Or one person in 5000 who has fibromyalgia. That it's. Cycle, but it also could be one person in ten or one in five. Like, we just don't know. Nobody's done the research with Irritable bowel. We know that nicosensitivity is very common. Some of that research is just starting to come out.

Another interesting one is lactose intolerance. And so we know that people who are lactose intolerant, that if you're lactose tolerant, you're more likely to have dietary nickel sensitivity and vice versa. And we don't know if it's the dietary nickel sensitivity causes the lactose intolerance or the lactose intolerance causes the nickel.

We more think is that the nickel sensitivity causes the lactose intolerance because of the inflammation in your intestines. But that's another group of people. But again, the most common that we know of right now, the Dyshydronic eczema, the little itchy blisters on the hands, that's the one that we know is the most common manifestation.”

Laura: “So if someone knows that they are allergic to nickel on their skin, should they be considering a low nickel diet?”

Dr. Zirwas: “Absolutely. Now, first thing that I would say is if you just get rashes on your earlobes when you wear cheap jewelry, but otherwise you feel fine, if you're like. Well, I don't have any intestinal problems. I don't get any rashes anywhere else on my body. I don't chronic fatigue. My energy level is good. I feel fine. Then you probably don't need to try a low nickel diet because the amount of nickel you're consuming is below your threshold. But if you have in your life gotten reactions from earrings or rashes, where your belly button, where your belt buckle is, and you're getting rashes, that you can't explain whether it's on your hands or anywhere on your body, should try a low nickel diet if you have ever had those symptoms and your energy level isn't where you want it to be if you've got GI symptoms. arthritis, if you have headaches, if there's some nebulous symptom that no doctors have been able to pin down of, here's why you are getting that you should try a low nickel diet. But we know that only about 50% of people and that number is arguable I think it's 50% of people whose immune system reacts to nickel. Only 50% of them will get problems from earrings or belt buckles. And that's because to get the problem from the earring or the belt buckle, it requires two things.

Your immune system has to react to nickel, and then number two, your skin surface chemistry. So, right, each of us, our sweat is a little different, PH a little different, salinity, the natural oils on our skin are a little bit different. And so you both have to have a skin surface chemistry that causes the nickel to be released from those items, and you have to have the immune system that reacts. So even if you've never had any of those symptoms.. If you got a rash on your hands or GI symptoms, or those other things, it really makes sense to get tested. And it's a pretty simple test to find out if you're allergic to nickel, and then if you are, again, you should try the low nickel diet. And I generally recommend people try the low nickel diet for about three months, and if they see be some improvement in their symptoms, then it really becomes maybe trying to optimize low nickel diet.

There are maybe some supplements that you can take. I don't generally don't recommend the supplements as a first step, but if you do it for three months and don't notice any change in your symptoms, then I would say, you know what? It's probably not nickel. Probably isn't what's driving this. But even if you notice is some change, you feel somewhat better. Then I would really stick with it, try and get stricter, try and use the supplements, those kinds of things.”

Laura: Yeah, and that was definitely some of the questions that we got. And it's probably coming from people who are trying to optimize as much as possible. These are some of the things we did talk about in our book, but things like what supplements do you recommend? A lot of people already know about the vitamin C with every meal, but some people vitamin C, so they asked about iron and what you thought about that. So what kind of supplements would you say are potentially helpful?

Dr. Zirwas: “So the vitamin C has some data to back it up. I will say I haven't seen it do much the iron I'm not convinced I've seen really do much of anything. Doesn't hurt.

Right. And the idea with this, where the vitamin C comes from, and there was a study where they tried giving people nickel, measuring the nickel levels in their blood, and tried giving it to them with various other things to see. Did the giving it with those other things prevent?

The nickel from getting absorbed up from the food into their blood. So that's where the research about the vitamin C comes from. And researchers that has some effect, but I don't think it's a big one. The supplement that I have had by far the most success with, and I want to be really clear, this is not medical advice for anybody. Talk to your doctor before you do any of this stuff. But the best study out there and the thing that I've seen work the best as a supplement is something called di odium EDTA. So disodium EDTA is an approved food preservative, and it's what's called a chelator. And so the way that it preserves food, it helps to bind the trace minerals so that then they're not available to bacteria. Well, the di sodium EDTA, there was a study done, I think it was in the 80s, where they gave people nickel and tried giving it.

And this is actually where the vitamin. C thing first came from. This helped a little, but the EDTA. When you took high nickel ingestion together with a little bit of disodium EDTA, not only did none of the nickel get into your blood, the di sodium EDTA in the intestines binds the nickel so tightly that it actually pulls nickel out of your blood into your intestines so that then it gets removed from your body whenever you go to the bathroom. Now, here's the danger with the disodium EDTA. You can die if you take too much of it. So there's another supplement called calcium disodium EDTA that's safer than the disodium EDTA, and nobody dies from that one. But it also doesn't work. So they've studied that one's been studied as well, and it doesn't work to bind the nickel. So the reason the disodium EDTA can kill people is it doesn't just bind nickel. It also binds calcium and other minerals and can induce a deficiency of those other minerals if you take too much of it. And that actually can be fatal, can lead to cardiac arrest and those kinds of things. So the data really is in this study, the amount of disodium EDTA you need to take is a really tiny little amount. So it's 40 milligrams each time you eat, and you can buy the di sodium EDPA as a powder on the Internet. And what I recommend to my patients is that you get a little scale that's got sensitive down to the milligram level, and you actually measure out 40 milligrams doses, and you put it into a bottle of a regular 500 milliliter, 16 ounce bottle of drinking water. Anytime you eat a meal, you drink that bottle of water with the meal.

That's a really tiny little dose of disodium DTA I've never seen. And so you might drink three bottles of that water a day. Never seen that cause any problems in any patient I've ever recommended it to. But I really want to emphasize, if you're going to try and do the disodium EDTA, you absolutely cannot take more than the 40 milligrams, probably four times a day. So one bottle with each meal, and then maybe one more bottle that take a couple of sips whenever you have a snack, but you don't do any more than that. And you got to be really careful to make sure you get the measurements right, because people have died from it inducing these deficiencies. So you have to be really careful. But again, it is disodium EDTA. You can't take calcium disodium EDTA. That one doesn't work. And second, not a replacement for the diet. So if you're not on a low nickel diet, the amount of calcium or the amount of di sodium EDTA you're taking is not going. Be enough to get rid of the nickel without inducing other deficiencies.

So you've got to do a low nickel diet and then you can sort of supercharge the diet by taking these tiny doses of di sodium EDTA together with it. That's the supplement I've seen work the best. I do think that the 1000 milligrams of vitamin C with every meal can make a difference. Iron, I'm not so sure, but the disodium EDTA is absolutely what I've seen work the best.”

Laura: “Do you recommend any probiotics at all?”

Dr. Zirwas: “So I absolutely recommend probiotics in general. So I try really hard to only recommend things that I have. Tony strongly recommend things that I have really clear data that here's a study and we know that this works. Now, I also want to. Stop right there and be really clear that just because there's not data that something works does not mean that it doesn't work. Right? There's an infinite number of things that could be studied, and there's never going to be. They've all been studied. So just because there's no data, whatever. I'm like, I haven't seen any data, that's not me saying it doesn't work. That's just me saying I don't know if it works. And because when you hear people say, well, but I did this and I felt so much better absolutely. That could have been that you felt better because you did that. But it also could have been some random coincidence. It could have been placebo effect. And I do talk about placebo effect.

It often gets like a bad name. Placebo effect is one of the greatest things in all of medicine. And placebo effect even works with knee surgery, right? So they have done fake knee surgery on people where they put them to sleep, make a cut, don't do any knee surgery, stitch the cut. Back up and depending on what kind of knee surgery you study, that works just as well as actually going in and cleaning the knee out. Right? So placebo effect isn't like just a dread. It's a real physiologic thing. But so I try to stick to things that only have data.

However, let's go back and talk a little bit about probiotics for a minute. So number of things in dermatology that probiotics have been shown helpful for, where the thing that I've seen the best data for is for atopic dermatitis. And I actually think that many people who are diagnosed with atopic dermatitis, it's actually nickel sensitivity, dietary nickel sensitivity that's showing up as a nonspecific rash. And because their dermatologist isn't tuned into dietary nickel, it just gets called atopic dermatitis. But we have really good evidence for certain probiotics. Now, you can't ever say take a probiotic. That is just anybody who says take a probiotic. And doesn't give any more advice than that is just dumb. Because the first question is, why are you taking the probiotic? And the best analogy that I've got for this is let's say you lived in a high crime neighborhood, and you came and said to me, hey, what should I do to help make sure that my place doesn't get broken into?

And if I said if you were somebody said, I have eczema and nickel sensitivity, what should I do? If my answer was take a probiotic that is the equivalent of the person who says, if I have a high crime neighborhood, how do I not get broken into? If I say get a pet. Well, getting a pet could mean you got a goldfish. That's not going to help. It could mean you got a horse living out in a farm somewhere. That's not going to help. Right. So when you say probiotic, it's truly equivalent saying get a pet. So it's oh, okay. I would say get a dog. Okay, you're still and I'm I'm being a little bombastic here, but that person is get a dog still. You're an idiot. Right. If that person a high crime neighborhood, what should I do? Get a dog. And I don't give them any more advice. Well, okay, get a two pound teacup poodle. Is that going to protect you and prevent people from breaking into your place? Might help a tiny bit because the barking is going to make some noise, but no, it's not. You have to tell them what kind of dog to get, right where that comes into with a probiotic day, get Bifidobacterium longus, get lactobacillus, whatever, because those are individual species. But all dogs are the same species, right? It's just they're different strains. Now, in probiotics, we call it a strain and a dog, we call it a breed, but a two pound teacup poodle is the same species as a rotweiler, right? But there's just two different strains. Same thing with probiotics. So you've got to get the exact strain.

And so the probiotic that I recommend for atopic dermatitis and eczema patients. In general, it's one that you get on Amazon. It's $8 a month. I have no financial connection with them, neither with Amazon nor with the probiotic. It's $8 a month. It's called now. So the brand is now no Probiotic ten. And they make a 10 billion or 25 billion or 50 billion, 100 billion. I recommend the 25 billion costs $8 a month.

So it's about 28 bucks a month? It's about $27. For 100 pills, you take one a day. And the other thing with probiotics, you have to take them with food. So there's been one study ever that looked at this and probiotics taken with food have a much higher rate of making it into your small intestine than probiotics taken on an empty stomach.

And that makes sense from an evolutionary perspective. Right. Where do we think that the intestinal microbiome developed from? With the bacteria on the food that Are ancestors were eating? Well, they were walking around in the woods picking stuff up and eating it that was covered with bacteria. They were never taking the bacteria on an empty stomach. Right. They weren't walking around. The woods being like, oh, that looks like a disgusting mold growing on that. I'm just going to eat the mold and not eat the food. No, that is what you're doing if you're taking a probiotic on empty stomach. So you always take a probiotic with a meal. But that's the probiotic that I recommend. I've seen no data on it in particular for dietary nickel, but there are randomized double blind there is at least one randomized double blind placement control trial showing that four of the strains in there did make a difference in eczema. So that's the probiotic that I recommend.”

Laura: “As far as gut health is concerned and intestinal permeability, what role do you think that plays in the amount of nickel that is absorbed or the amount that someone gets a reaction to nickel?”

Dr. Zirwas: “So this first, let me tell you, is pure speculation. No good data on this. But I'm also not somebody when I say no. Data? I'm not going to say, so I can't tell you any. Well, I have an opinion on everything. And so my strong belief is that intestinal health and gut permeability play a huge role. But I think the problem is once you start to get a dietary reaction from Nickel, it causes its own intestinal permeability problems. And so we know what happens if you ingest Nickel. What happens is that the white blood cells, which are the main, that's what makes up your immune system. They leave your blood and go into your intestinal wall and they cause damage and inflammation in the intestinal wall.

So that's causing increased permeability. But that inflammation they're causing in the intestinal wall also allows substances called cytokines to leak. Out of the cytokines that those white blood cells in your intestinal wall that are reacting to the nickel that they're making are leaking out into your blood. And all of this we have great data for. And cytokines just the way that you think about what those are. Cytokines are how your immune system communicates. So there are hundreds of different cytokines. They each have different names. But essentially, this white blood cell makes the cytokine, and then it tells this white blood cell what to do or tells your skin cell what to do or your liver cell what to do or whatever.

Cytokines are just a way for your immune system to communicate. And so the cytokines that those white blood cells are making in your intestinal wall leak out into your blood, and that's what causes the systemic inflammation. And again, none of that is none of that is like well, we have studies where they give people nickel. They see that the white blood cells all leave their blood. They then do a biopsy. Of they put a scope down their mouth, do a biopsy of their intestinal wall, show that those white blood cells,

they left the blood, it's because they went into the intestinal wall, because whenever you biopsy, you find them. And then if you measure the cytokine levels in their blood, you can see which ones go up and which ones don't. This has all been very well worked out and proven. This is the most concretely, absolutely proven, direct cause of an inflammatory diet that exists. And I mentioned this earlier. It always amazed me that nobody knows about this. But the reason nobody knows about it is, until your cookbook, we had no idea what to tell people. So it was kind of like, well, this is probably what is making you feel so sick, but I don't have any advice for you. Good luck. See if you can figure it out on your own, which I kind of know is your story, but actually did figure it out, which is how we got the cookbook. Now that we've got an answer for people, which, hey, go get this cookbook and follow this. That's what has me so excited.

Because we've got the data. We know this is a big problem. We just never had a solution until you gave us one. So thank you.

Laura: “I do think some of the data was out there. Even you published a list of low nickel foods, and there are lists of these foods everywhere. And I know that doctors and dietitians have been giving these lists to people, but for me was we haven't talked about this yet, but the recommendation is to try to keep your nickel intake below 150 micrograms per day. Which who measures their food in micrograms or what labels will have nickel in micrograms or nickel listed on it at all. And so it was really onerous to figure out, how do I make sure I'm eating below the certain amount?

That's why I tried to write the book the way that I did. So that how. How would the average person be trying to put together a meal? And how can I let them use that language that's normal to them to be able to transfer into the 150 micrograms a day?”

Dr. Zirwas: “Yes, because the problem was the list, right, that we took the data from, I think the US. FDA or somebody published the data and we converted. But so, like, 500 different foods that each have a different point, and you're going to try to figure out everything you ate all day. It's not like the simple diets of like, okay, follow FODMAP, avoid these eight foods, or follow Paleo, only eat whole 30, only eat these things for a month. Well, you got to do this for the rest of your life. And so there's no, like, oh, for a month, like, really? Be sure. You got to do this forever. It was impossible, right? It was just literally impossible for what I would call normal people. And. Even for actually, I'm not sure even for not normal people, I think it was pretty much impossible because it was just so complicated and the amount of effort it would take was insane.”

Laura: “Especially when you're first starting. Usually you have really bad symptoms. Your symptoms are really bad. That's how you finally got the diagnosis that you did or finally did the research it required to figure out what the problem was was. And so when you're really inflamed, when you're itching everywhere.

Like, for me, I couldn't use my right hand at all because it was so covered in scabs. I couldn't use it. I couldn't cut my food or anything. And I wasn't leaving the house because I was also covered in eczema everywhere. So it's really hard when the thing that's supposed to help you is also very complicated and hard. That's just really hard to deal with. “

Dr. Zirwas: “And we're not even talking about the part of it that, and I've never seen data that really proves this, but it is my firm belief that even the foods that we think of as low nickel, the plants, right? So we're talking about plants. We're pretty sure that when it comes to meat and dairy, that there's almost never high nickel and meat and dairy. But when it comes to plants, even the things that are supposed to be low nickel, if they're grown in really high nickel soy oil, probably they become high nickel. So even if you're following the diet really well and like, oh, I don't know. I think of broccoli as a relatively low nickel food.

And if you were like, oh, I love broccoli. That's on the thing. I'm just going to eat a ton of broccoli. I was a little bit of this and a little bit of that. So that I'm not, but that's like but I'm going to try and follow a ton of broccoli. And then it happens to be that the broccoli you're getting is coming from know, Chile from farms that are super high in Nickelodeon. I don't know that chile has high nickel soil. I'm not trying to say that. But whatever you could be giving. Soap, a huge amount of nickel in your broccoli and not know it.

You're following the list really. It's just really challenging.”

Laura: “Or you take a bunch of low nickel foods, but you eat so much of that low nickel, it still builds up to too much nickel. It's a lot to consider and to weigh out, so it can be really frustrating. So we tried to make it

as easy as possible, for sure, that and you did mention something that some people were asking about, which was . . .

is it possible to ever heal completely from this? Or do you have to be on this diet your whole life? What have you seen?

Dr. Zirwas: “So here's what I've seen. And we just got indirectly some data that backed up what I've seen clinically. So what I've seen clinically. So the way that you think about your immune system working when I say your immune system reacts responds to nickel, what it means is the way you think about your immune system immune system is made up of these white blood cells and the ones in particular. That are most important for our purposes are called T cells. I don't know why they're called T cells. I'm sure I learned in medical school, but they're called T cells. And each T cell has one particular thing that it reacts to. And now there might be this particular T cell react to that one thing. Now, there might be a million of these T cells in your body. So I'm not saying there's only one T cell that reacts to that, but each T cell pretty much has one thing that it reacts to. And what I've always thought was that when you're in bad, those T cells, because what they think they're doing is fighting an infection. And so when you're bad and you've been eating a high nickel diet, just not knowing you were going so that it was a problem, your body's making more and more and more and more of these T cells.

And so it's like the army keeps growing and growing and growing. So it takes very little nickel to stimulate a bunch of those T cells. But then when you start to avoid nickel, your body starts to say, oh, we don't need to make those T cells. That, that thing that we'reacting to there's not so much that we don't need to make so many. And so I've always thought that the number of T cells is going to go down over time. And then if that happens, as it gets low enough, if you do start to eat a little more nickel, you're not going to get symptoms right away because the T cells not only decrease in number, the ones that are there get kind of sleepy.

And so then if you do eat a little bit of nickel, by the time they have to wake up, they have to replicate. And then by the time they're ready, the nickel is out of your body. And so I always saw that people would become less sensitive to nickel over time, but there are never cured in the sense that they're always going to have those T cells there. And if you start to wake them up, you're going to. You're going to now be a little more sensitive. And then if you're a little more sensitive, so you can get back there, but how sensitive you are goes down.

And just out of interest, the study that we saw this in was really cool. It was looking at vaccine reactions. So a lot of vaccines have some aluminum in them, which helps to stimulate your body to react against whatever you got vaccinated against. And kids can become allergic to the aluminum in the vaccines, and they get like, a little lump where they got the vaccine. If you take kids who get that little lump,

about 75% of them will test positive to aluminum. If you then don't give them any more vaccines or any more aluminum, because your immune system doesn't really get exposed to aluminum anywhere else, about five years later, 75% of them won't react if you retest them. And then five more years later, another 75 won't react. Another 75% won't react. So we get down to like 5% of the initial people will still react. But I'm certain if we started to give them aluminum shots again, they would all start to react pretty quickly. But it really confirmed this idea that if you can reduce exposure, the level of reactivity goes down over time, but it never so the other thing, which I know you're very aware of, there's this group in Italy that have really been some pioneers in the nickel systemic nickel reaction world. So they often use the term SNAs systemic nickel allergy syndrome.

But they have developed a nickel desensitization protocol where basically you intentionally take you make nickel drops and you take a certain number of drops and you slowly build up how many drops and they have published really good success with that. When they first started to said, I got all excited about it. It took me three months to figure out how to buy nickel. So I bought nickel and distilled water and measured it and made all. These different dilutions of nickel. And I have a patient's coming in, and I'm giving them little dropper bottles of nickel, and I'm like, okay, put one drop under your tongue for and they would flare initially. And I was going to do it. And then what was frustrating about it, though, I absolutely saw their chest reactions to nickel would get better. And so after they were on the drops for a while would test them. And the tests that were used to be positive were now negative, but their symptoms actually never got better.

And so I actually gave up. I don't do the nickel desensitization anymore. I tried it for a while. I didn't see it help. But that is not me saying it doesn't help. It's me saying because the group out of Italy really published compelling data, which is why I went through all the effort of trying to replicate their protocol. I just didn't see the same results. But it may be something that works because they think of that as a cure. But I was not able to get there with any of my patients whenever I tried it.

Laura: “Yeah, that's all really helpful to hear because I know for myself, in the last year, I don't think I've had one outbreak at all that's for the first time. And I haven't been as strict with eating low nickel. I still eat mostly low nickel, but I've had some chocolate cake or I've had some nuts or something like that that normally . . . “

Dr. Zirwas: “oh, my God. Lord, shame on you. Yeah. Chocolate cake. You had nuts.”

Laura: “Chocolate has so much nickel. But yeah, now I can have a piece of chocolate cake and the next day I'm not itching my hands and getting bumps on them and stuff like that, which is so great. But but I wasn't sure does that mean that my T cells have died off and now I'm good? It's good to know that I should continue to still just be cautious and not try to stack a lot of nickel back to back, because I definitely do not want to go back to how it was before, and it took long enough to get where I am now, so that's really helpful to know.”

Dr. Zirwas: “Yes. By the way, this is Cinnamon that we're getting cameo from. His sister Sugar might come, and she sometimes likes to give a cameo as well. Nice.

Laura: “Yep. Dr. Cyrus is a cat person. It's a beautiful cat.”

Dr. Zirwas: “Thank you. They're so much fun. I love cats. I don't understand dog people. Dogs are so boring. They're so easy to know. You know your dog's going to be excited to see you. That's no fun. I want to have to work for it, right? I want to have to learn how my cats like to be scratched and petted. I like to have to work for it. “

Laura: “Yeah. There's pros and cons, for sure. You definitely can't have a dog when you're in med school or residency. No, you cannot. A cat. You could yes.”

Dr. Zirwas: “Laura, actually, I have a question for you. So one of the things that I definitely knew about the low Nequa diet and the list of stuff that I told people to avoid was I was always telling them like, oh, and by the way, there is like zero fiber in what you are going to be eating. And so I would always have people start taking a stool softener. And so and I know I think you and I, you mentioned once to me that was part of why you wrote the book, was that as you worked on following the low nickel diet, you were like, this is a really unhealthy diet. I may be getting better from my rashes, but I'm going to die from heart disease and GI cancer and whatever.

What did you eventually find that's high fiber that or is it just lots of leafy green vegetables? Or where's the fiber come from in the diet that you put together?

Laura: “Yeah, that was actually one of. Questions that someone asked, worried about how the low nickel diet is unhealthy and what our thoughts are on the lack of fiber and cholesterol and heart health concerns and stuff like that, which is totally understandable considering what we've been taught over the last 40 years or so about what a healthy diet is. But when I looked at the list of foods of what a low nickel diet entailed, a lot of the lists had things like sugar and white flour, things which I know are not good for us, and they're bad for your heart health, for sure. That's where a lot of heart disease comes from, is diabetes and inflammation, which we know high carbohydrate intake and high sugar intake. Causes that.

So for me, I already knew the science behind the fact that the American Heart Association and the American Medical Association about five years ago, they came out and said that actually they don't recommend lowering dietary cholesterol anymore. That it doesn't impact the body cholesterol in the way that they lot.

And that cholesterol wasn't the biggest concern when it came to heart health. But that's not been spread in people's awareness. And so that's why I think a lot of people worry about eating so much meat and worrying about fat intake and all of that. My recommendation is to just try to eat as balanced of a diet within the confines of this diet as you can.

As far as . . “

Dr. Zirwas: “but you took all it like that's the as you were developing. The diet, you intentionally made sure that it is still a healthy diet. Yeah. If you're following the meal plans in your cookbook, you're getting a well balanced diet, because it truly was like, people would ask me, like, Dr. Zirwas, am I going to get deficiencies? And I would be like, I don't know. They'd be like, well, can I take a multivitamin? And I'd be like, Well, I don't know, because they may have nickel in them, and we don't know if they have nickel in them. I assume you took all of this into account as we're developing the meal plans.”

Laura: “A couple of things. So first, obviously, I couldn't promise that everyone's going to get every single thing that they need in the perfect amounts, because I can't do that because it depends on what you choose to eat and where you get it and how you cook it and all that kind of stuff.

But I can say that the way that I chose the ingredients that are in the book and the recipes that are in the book is that. Used diets that are considered standard of care in medicine that usually come along with people who have systemic nickel allergy. So IBS GI issues the standard of care for that is a diet called the low FODMAP diet. And when it becomes standard of care because it's so well supported in research and so people are able to eat a low FODMAP diet and get all of the nutrients that they need. I also incorporated the Mediterranean diet. I incorporated the low Carbohydrate diet, both of which are used for heart disease and diabetes.”

Dr. Zirwas “And those things also are comorbid with nickel allergy and with the systemic inflammation, right? Because certainly think of systemic inflammation as a big driver of heart disease. And so people who have been living with a systemic inflammatory state because of nickel in their diet, I think. We have no data that says people who are eating low nickel have a higher risk of heart disease. But it has always made sense to me that that systemic inflammation would have increased their risk for vascular disease in general.”

Laura: “Yeah. And obesity also is comorbid. You can't say the chicken or the egg. Which thing comes first? Do they come together? But the way that sciences supported what types of diets we should be consuming to help support the healing of those conditions, that's what I kind of put together. So I grabbed elements from all of those diets and then made sure that they were low nickel ingredients and also had good ingredients that support gut health. Because I think the most healthy we can keep our gut lining and our gut health, then the correct amount of things will cross the gut barrier or less. Nickel will cross the gut barrier as well and will keep the inflammation down. Because like you said earlier, the more inflammation that's going on in the gut lining, the more things are going to cross into the bloodstream.

So all sorts of things cause that. Research has shown alcohol causes that, stress causes that not getting enough sleep, drugs. There are a lot of things that can increase gut permeability on top of just nickel.”

Zirwas: “This, what I'm about to say is getting a little off topic and then we'll get back on topic, but I just read something and an allergist told me this. Maybe three months ago, she actually called the crunchy allergist. Her name is Kara Wata. W-A-D-A. That there's now suspicion that dishwasher rinse AIDS are a significant contributor to gut mucosa interruption, so, SIBO and those kinds of things. Ah. Because these dishwasher rensaids are essentially film disruptors and they're used at very high levels in the commercial setting. So in restaurants, because if you're going to pay $16 for a glass of wine that really only has a dollar worth of wine in it, you really want a glass that doesn't have spots on it. So they use a lot of dishwasher rensaids and their suspicion that that may be interrupting the integrity of the mucosal lining, which is just fat. Like just that the kind of stuff nowadays that we're finding out. It's not like phthalates and BPAS and the stuff that we've been worried about. It's like the stuff that nobody was worried dishwasher bensaids. Yeah, of course it's going to be something like that.”

Laura: “That makes sense. I've never heard that.”

Dr. Zirwas: “Awesome. Yeah. So, right, let's get back to Nickel. “

Laura: “Yeah, that's how I chose to focus the book, because that's how I wanted to eat. And I know that other people may have different ideas of the best way for them to eat, and they're welcome to do that. But I made this book for people who wanted to try eating it as healthy as they could that also follow that way of thinking.”

Dr. Zirwas: “Just quickly, one of the other things I loved about the book was that you gave people at both ends of the spectrum good solutions. So you have a very well defined if you want to do a very, like, just here's exactly what to eat, you give people that. But then you also give people the maximum flexibility by saying, here are things that you can do substitution wise is by this, for this. So you give kind of the maximum both the maximum flexibility for the people who want. That and the just tell me what to do, you give people that as well. I just can't tell you how much I was impressed, how impressed I am with the book”.

Laura: “Thank you so much. Yeah, it took a lot of effort to do that, but I recognize that people are in different situations, and they may not have access to the same things that I have in those recipes. So I wanted people to have the options, especially if they're going to feed their families with this as well, to make it easy on them, that they can add some of those things in, that maybe their family members would want to eat. I've worked with a lot of people, nutrition, clients, where they're trying to do a hard diet, but their family doesn't want to eat it. And you want to make that easy for them.”

Dr. Zirwas: “Yeah, that that conversation made me think of another aspect of why I think Low Nickel is so another reason it's so tiny. Right now as we talk about kind of the differences in people's lifestyles. So one of the interesting things that came out of the literature about over the last 15 years is that one of the biggest risk factors for having an immune system that reacts to Nickel is the number of things you have pierced. So number of piercings directly correlates with how likely you are to have an immune system that recognizes Nickel. And that's historically why Nickel allergy was much more common in women than in men, because historically, women were much more likely to have their ears pierced, and men were much more likely to have nothing pierced. But the data has shown if you have three ear piercings, you're more likely to be allergic to have Nickel reactivity than somebody who has one ear piercing. And if you have three ear piercings, two nose piercings, a belly button piercing, and nipple piercing are much more likely to be allergic to nickel than somebody who only has three ear piercings. As diversity of lifestyles become, thankfully, more accepted and we see more people who are getting more piercings. I think we're probably also this is probably part of why we're seeing I think over my career, I'm seeing more and more people who are having these systemic reactions to nickel that's a cat out of the bag kind of thing. So if you've got a bunch of stuff pierced, don't be like, oh my God, I got to take my piercings out. No, it's actually when the piercing happens in the healing process from the piercing is when we think the nickel reactivity happens. So if you got a bunch of stuff pierced, just not going to do any good to take the piercings out or anything like that. Just wanted to make sure that nobody was going to listen to this and be like, oh my God, I've got to either live with these. Symptoms or take on my piercing? No, taking your piercings out is not going to make any difference at this point. And I also want to be clear. It's not like, oh, if you've got 20 piercings, you are guaranteed to be allergic to no. You could have 200 piercings and still not be allergic to nickel. You think of each piercing as kind of like buying a lottery ticket, where now it's a lottery ticket where if your ticket gets picked, you lose, you don't win. But my dad played the lottery for 50 years and never won.

Right? So it's not like, oh, if you get a bunch of piercings, you're definitely going to. But we just know, just like with the lottery, the more tickets you buy, the more likely you are to win. The more things you get pierced, the more like you are become allergic to nickel. Just wanted to make sure that I wasn't giving any wrong impressions. Yes.”

Laura “One of the other correlations that we know about in the literature that people should avoid is smoking. Smoking cigarettes increases your chance of getting I actually did not know that.”

Dr. Zirwas: “I can absolutely believe it. If there's one thing that we know that is bad for you in every possible way, it would be smoking. Yeah. There's a paper that they tried to look at smoking and alcohol intake, and if either of them increased the sensitization of nickel and alcohol was not at all, but cigarettes was.”

Laura: “And then also you get nickel in cigarettes when you smoke them. And so if you know you're nickel allergic, you should definitely not smoke, but it also increases your chance of getting sensitized.”

Dr. Zirwas: “Any literature you're aware of about cannabis and nickel allergy? I've never seen anything. “

Laura: “Somebody did ask a question about cannabis on reddit, but I hadn't seen anything on it. “

Dr. Zirwas: “Okay, let me give my general cannabis answer. Yeah. I'm not convinced it actually helps with much, but whatever's wrong with you, you won't care as much. There's still some benefit. “

Laura: “Yeah. I'm just going to go back real quick to our earlier conversation. Something that I did want to mention about when people worry about the diet being unhealthy. Something that I want people to remember. I understand if you're concerned that maybe the low nickel diet may not be your ideal,

healthy diet. That right. Now what's most important is for you to lower the inflammation in your body and to lower your symptom burden to try to calm down your immune system and get in a healthy place. And I would really recommend to focus on getting to a healthy place first and calming everything down. And then you can start worrying about how you can maybe make some Tweaks in the diet that will make you feel more healthful. Because you can try to eat the most healthy diet ever but have all this nickel and then you're not going to be in a healthful state if you're allergic to it. Right? Yes.”

Laura: “Okay, so going into kind of from this topic, it's something that we've talked about before. We even talked about maybe putting it in the book, but we didn't end up doing it. Some people wanted to know what you thought about the trauma, connection between trauma and all of a sudden getting nickel allergy be.”

Zirwas: So which kind of trauma? Well, right, because multiple kinds. Because we know some women get this after giving birth. Or being in an accident. That's what happened for me. I had a brain injury, I got hit by a car, and within six months, this allergy came about first. And just so that we remember to get back to it, I want to talk about Hormonal influence as well, so absolutely. It is a relatively routine, relatively common story. I get that somebody had surgery or a trauma, most commonly a car accident, but surgery or a car accident and there's nothing particular about car accidents. That's the most common source of major trauma that happens to people. But surgery for any reason, heart surgery, joint replacement surgery, whatever, and then they start to develop symptoms after that. And there's almost no way to prove this, but the belief is that what? When you go through surgery or a major trauma, and you've got to remember from your body's perspective, surgery is a major trauma. Right now, I'm not talking like, oh, I got a little I'm talking, like, heart surgery, joint replacement surgery, major surgery, right when you cut through your body, as far as your body knows, you just fell off of a cliff and are in this horrible state where your body's got to heal and fight off infections. And so any major trauma or damage your body, like, that triggers this stress response. And when I say stress, not like stress, oh, I'm worried like stress, it literally physiologically stresses. Your body and immune system on red alert. And so then anything that you're getting exposed to, you might have been being exposed to. For 30 years and you never had a problem. And then after a major trauma, your body starts to react to that thing. And that thing, I think, is very commonly nickel, but I've seen it be lots of other things as well. But that stress puts your immune system on DEFCOM Five and is now looking for anything. And the problem with allergy, g, hypersensitivity, allergy to things like nickel, once you get it, you've got it forever. So although the stress, your body's healed over six weeks after the surgery. Yeah, but if you developed an allergy to nickel during those six weeks, it's not like once the body's healed, that allergy goes away. Those T cells that we were talking about earlier, once you've got them, you've got them, and we don't have a way to get rid of them. And so there's definitely my experience. Experience is that a preceding trauma or surgery absolutely seems to be a common trigger for dietary nickel reactivity.”

Laura: “Okay. Along the lines of surgery, some people were asking about metal implants and dental fillings, if they should worry about implants, that while they may not have nickel having other types of metals. And then if people should get their fillings removed or worry about that, what would you say to them?”

Zirwas: “I kind of love this topic. And first I'm going to be really clear. This is one that I debate with many of my dermatology colleagues, and it isn't one I think a lot of times whenever I say I debate people, what I'm really saying is obviously I'm right. I'm just trying to explain it to them. This is one where I'm not sure. That who's right. But when you talk about nickel release for metal items, it's really crucial to think about the quality of the metal. And that especially goes with steel. And so high quality stainless steel, it is nearly impossible to get it to release nickel. So the difference between stainless steel and regular steel, stainless steel has some nickel in it.

Low quality stainless steel can release a lot of nickel. But high quality stainless steel, or surgical it's often called surgical stainless steel. But there's even grades even then, of surgical stainless steel releases essentially zero nickel. It's really hard to get it to release any nickel. And so implant, joint implants, I'm actually a believer that I don't think that joint implants. Are ever a cause of significant inflammation due to nickel. Now, when I say ever, I want to say like, I'm sure it's not a never, but unbelievably rarely. And my colleagues will often say, well, but I had a patient and they had a knee replacement. And then it was hot and swollen and we tested them and they were allergic to nickel. And we had them take it out and put it in a titanium one. And they got better and it so it was the nickel. Well, I've had three patients. We did that exact same scenario. None of them got better whenever we took this angle out and put the titanium in. And I've had plenty of people who were worried about nickel and so just had a titanium put in in the first place, who then still got pain and swelling around the joint me. Now, all of that is in medicine, what we call anecdotal evidence. And we're trained very strongly in medicine to not make. Conclusions on anecdotal cases. There was one study that I'm aware of that I've ever been able to find. It was done in China. Because the real question is, if you're allergic to nickel, do you need to avoid getting a know a stainless steel joint?

And they actually did a study in China where they tested people and find before surgery see if they were allergic to nickel or not. And then regardless of whether they were allergic to nickel or not, they still put in stainless steel, which this is intuitively really hard, because it's really hard to ever be like, well, you're allergic to nickel, but go ahead and have them surgically implanted into your body, you'll be fine.

That just sounds insane. So I'm always looking at from the question, if you've already got the nickel in there, do you need to get it taken out? I'm a believer that, like I said, I think it's very rare that the nickel is being released from the joint. The issue, and the risk of the surgery is probably much greater than the potential benefit. But in this study in China, they tested people ahead of time. Then even if they were allergic to nickel, they put the joints in them. And the people who were allergic to nickel and got a stainless steel joint put into them had no increased rate of complications, post op pain, inflammation, nothing. And so that study really supported that the quality of the metal that these implants are made out of is so high that even if you're allergic to nickel, it's okay to get one put in. And I definitely fall into that category. Now, as I said, I debate this with I have many really smart colleagues, and this is not one of the things where I'm like, I'm right, they're wrong. It is totally possible I'm wrong on this one. But the Me, the most relevant, highest quality data, has said that you don't need to get a joint taken out.

Now, fillings fillings are a different. Story. Fillings are very low quality metal. So I can absolutely imagine Amalgam fillings, releasing nickel and driving this. I'm not convinced I've ever seen that, though, because we would certainly expect those people to get symptoms in their mouth near the filling. So let's say you had a filling and that molar and it was releasing nickel and that was getting into your GI tracts and driving all this. I would expect you to have pain swelling in your mouth right next to the filling. And I have never seen that with nickel. So I don't think so. But again, that's one where I don't think so. I could imagine I've had patients who seemed to get symptoms in correlation with braces. Again, the braces. That they're made out of good and release nickel. But I don't think the steel quality of braces is as good as the steel quality of a $20,000 knee. So again, I could imagine it with braces. But I think there's even some data, though, that people who have had braces, braces here, are less likely to be nickel allergic. And we think that's because at a controlled, continuous release of nickel, the Italian group has shown that that may actually lower your reactivity to nickel as opposed to the cutaneous exposure, which is the pure things that we know. That's how most people are allergic to nickel. Become allergic a nickel. That was a really long answer, but I could always summarize it all in saying, I don't know, but I don't think joints are a problem. I could imagine Amalgam, you know, metal fillings being a problem. I don't think braces are a problem, but I could imagine it. But overall, I don't know, and I don't think anybody knows that's one that remains, and it's very it's going to be very hard to ever find out. It's hard to even imagine how we would do those studies.

You did remind me of something else that I definitely wanted to talk about. I would imagine somebody asked about LTTS lymphocyte Transformation are, and if nobody did, people should be aware of them. So this is a blood test for nickel sensitivity.

The main problem with it is it seems to be way too sensitive. And, Laura, I know you as a medical student, understand what I mean by the term sensitive. Things that are too sensitive means they frequently have a false positive test. So you get your blood drawn, you send it off to this lab, it costs $600.

They send you back a report saying. What metals your white blood cells react to. Well, that is such an artificial situation, right? Your blood cells have been outside of your body for a day. By the time they get to the lab and you're putting them in a Petri dish, your white blood cells are like, what the hell is going on?

So I think they react to a lot of stuff they don't normally react to. So that if I was somebody who worried I was allergic to nickel, I wouldn't base my decision to do the low nickel diet on an LTT, to be honest. We also don't even really know the specificity of an LTT. Again, I know you know what that means, but specificity means if it is negative. So if you got an LTT, so if it's ultrasensitive, you would think, like, oh, well, so if I got one done and it was negative, then I'm definitely okay, that's called specificity. How specific is the test? Meaning that it is. Specifically only positive in people who have it. And if it's negative, you definitely don't have it. We actually don't even know the specificity. All of the literature, all of the evidence, everything I've talked about tonight is purely based on patch testing as our way to determine if somebody is allergic to nickel or not. And so if anybody out there has heard of LTTS are thinking about sending their blood off, for one, I do not recommend them. I actually don't know of anybody who does what I do, any of my colleagues who recommend them, just because we just don't have data to back up that they are clinically give us similar information to a patch test.”

Laura: “Well, that's a perfect segue into the last question I wanted to ask you, which is if someone's watching this and they think that perhaps they might have this allergy. And who should they go to or what should they do or what options do they have?”

Dr. Zirwas: “So the way that we diagnose a nickel sensitivity, the way that we show that your body reacts to nickel is something called a patch test. And in general, what a patch test is, we take a little patch. So the original guy who came up with this, like 100 years ago, I think his name was Dr. Yadison, used little patches. Now we use little discs, not little patches. But that's why they're called patch tests. So you take a very pure substance, in this case, talking about nickel, and you put it in a form that is very so right. We talked earlier about you can't just hold a nickel item on your skin because the nickel may not be bioavailable. Where you put the nickel in some kind of a gel or petroleum jelly and. In a very specific concentration of the nickel.

So I really want to don't try and do this at home, because if you're not allergic to nickel, you could make yourself allergic to nickel. But so when we're doing this so you take a tiny little bit of that substance and you stick it on your skin under a patch. Now, like I said, the patches that we use now are like these little tiny metal discs or little plastic squares that then we put that on and we tape it on there. We leave it on for two days. Then you take the patch off, and then you wait another two, three or four days to see.

Do you get a reaction at that spot? Do you get some redness, some swelling? So the easiest way I can explain it to somebody who doesn't do this, a positive test kind of looks like a mosquito bite. So red and raised. A mosquito bite or a bug bite. Just any bug bite in general. Or poison ivy, like red and raised. And that tells us. That when we held that nickel against your skin, your immune system recognized it and activated all of the data that we have, everything we know about dietary nickel, the way that we determine whose immune system reacts and whose doesn't. Because when we talk about that, there have been studies done. It's not just that they've taken nickel allergic people and giving them nickel and see how much you got to give before they get a rash, they will usually do these studies with a control group who had so the nickel group had a positive pass test to nickel.

The control group was tested to nickel, and it was negative. And in the people who have a test to nickel and it's negative, essentially, no matter how much nickel you give them, you cannot trigger a rash or anything else. And so the Patch test is what tells us, is it possible that a lone equal diet is going to help you? And so to get a Patch test done.

Most dermatologists can do a patch test, do patch tests for nickel. And I can't say if it's most allergists, but many allergists do it. Regular doctors don't do it. Gastrointestinal doctors don't do it. It's dermatologists and allergists. And if you want to get tested for nickel,

I would call a dermatology office, ask, do you do patch testing? Because you don't have to say, do you do nickel patch testing? Because if they do patch testing, I guarantee they do nickel patch testing. Call them, say, do you do patch testing? Okay. I would like to make an appointment don't say, I would like to make an appointment to get patch tested, because every single doctor's office in the world is appropriately going to say, well, we're not going to schedule you.

For the testing, but we'll schedule you to come in and talk to the doctor her to see if they think you need the testing. Right. It doesn't do you any good to get in the argument with the receptionist you're trying to make an appointment with. So, okay, yes, I'm going to come in and talk to the doctor by going to test Nickel.

In the book. I wrote a little section for you about how to talk to your doctor about this, how to request the nickel testing. Because most dermatologists and allergists are not even aware of dietary nickel as an entity. And so if you went in and are like, I think that my headaches and fatigue and bloating are from nickel that I'm eating, they're going to be like, I'm going to go see my next patient. They just have never heard of it. Right? So we got a section in the book. It's how to talk to the doctor about it. But essentially what I would go in and do if you really want to get tested for nickel, just go in and say, I don't talk about the dietary stuff, because that's just going to go they're not going to be knowledgeable about it. Just go in and say, I'm worried. I'm allergic to nickel. I think I've had some reactions to earrings in the past, and I want to find out they.

Then, okay, yes, we'll get you patch tested. They'll set you up. They're not going to patch test you just to nickel. They're going to patch test you to probably between 36 and 90 things. And those other things are worth knowing about, too. They're going to be things like the preservative in shampoo and the neosporin and rubber gloves. And so they're things that are worth knowing if you're allergic to them as well. But if you go and say, I just want to get tested to nickel, I don't know any doctors who do that. Even I would do it if somebody asked, but I've never actually done it. But they're not going to test you just to nickel. They're going to test you at a minimum of 36 things, maybe up to 90 or 100 things. But there are plenty of dermatologists and allergists who don't do patch test thing. So just don't just call a dermatologist or allergist to make an appointment. Make sure that they do patch testing, and just make sure that they do patch. Testing before you make the appointment, what will happen. You'll go in for that first appointment. They will say, okay, yes, we agree that we can test you. We're going to schedule you to come back. You'll come back in. They'll actually put the patches that I was describing.

They'll put them on your back, you'll leave them on for 48 hours. Then you'll go back to their office again, they'll take the patches off and look to see did you have a reaction. And then you'll come back 48 to 96 hours after that, because usually the reaction is not there when you take the tape off. In fact, it's pretty rare that it's there. When you take the tape off, it shows up typically in the 48 hours after you take the tape off, and it always lasts for at least 96 hours. So you want them to check you again. You want them to check the site, like 48.

So they're going to put the tape on, leave it on for 48 hours, take it off. Then 48 to 96 hours after that is when you want them to. Check it to see if there's redness inflammation, something that looks like a bug bite. And if there is, then it's very possible that you would benefit from the low nickel diet. If the nickel test is negative, in my opinion, I don't think it's worth your time to try the low nickel diet. There is data that would argue with that. There's data that says even people who test negative may benefit from the low nickel diet. That has not been my experience. So if your pest test is negative, I don't think it's worth trying. But there's data that goes both ways.”

Laura: “Okay. Fabulous. Was there anything else that you wanted to share with people about the nickel allergy?

Zirwas: I think we have covered it pretty well.

Laura: Nothing else?

Zirwas: “No, nothing else really comes to mind. This has been really fun. It's not often I get to really talk about this because not many dermatologists or allergists have been very interested in it. And so the depth of knowledge that you have about it makes this a really fun conversation to have.

You know what? There's one other thing that I do want to say, that I've only had a couple of patients ever do this, but it did really help them. And these were ultra sensitive people. In addition to everything else, they actually started growing their own produce. And in particular, they did it hydroponically, because if you just buy potting soil, it might be high in nickel. You don't have a way to know. You don't have no way to test it. But if the roots are pretty, it's just in water, and you're using distilled water, you know exactly what you've put in that water. So you can be sure that's the one way you can. Be absolutely sure that a plant is not high in nickel is by hydroponically growing. Now, the problem is you got to set up a pretty big operation to grow enough stuff, hydroponically in your basement to really make this a viable solution to grow enough food for yourself. But have had a few patients do that, and they did think that it made a really big difference for them.”

Laura: Yeah, I'm glad you brought that up because someone did ask about what she thought about hydroponic vegetables.

And I know one of your patients that you connected me with, she knows a lot about that. And so I'm hoping that maybe she'll share some of that information with everybody.

But thank you so much for doing this. I know everyone's going to be there already really grateful and really excited to see this and see what you have to say. . . .