Ichthyosis Awareness Month: Nutritional advice from a dietician.

Today my good friend, blogger and dietician Heidi will be providing some nutritional advice for people with Ichthyosis.

I gave Heidi an example of the food I eat on an average day (the food I cook from scratch rather than takeaway or restaurant food), and she offered some suggestions for my diet. Her tips may be useful for patients with many types of Ichthyosis, but as usual, I recommend talking with your doctor before trying anything new, especially if you or your child has food allergies - which is common in patients with Ichthyosis.

I prefer cooking with whole ingredients so I know what I am eating. I also eat a lot of food - I joke that I eat like a lumberjack!

Thank you to Heidi for writing this post. You can check out her wonderful blog here. And she takes the most amazing food photos so her Instagram is worth a look too. Heidi is over in America now and I am enjoying her seeing food journey very much.

(Heidi and I, before embarking on the epic pizza making.)

"I’ll be writing from an Accredited Practising Dietitian’s perspective in this post. Carly has asked me to write this post about nutrition in light of her skin condition, ichthyosis (you can read about it in Carly’s post, here). I was so happy to be asked to share my knowledge with her and her readers.

Ichthyosis and Diet

Currently there are a number of different therapies and recommendations for managing ichthyosis. Each individual is different, and depending on what type of therapies involved, individual requirements will change. There is no diet treatment for ichthyosis as such, or strict rules to follow, rather general recommendations to ensure that Carly is in the best possible condition to manage her chronic illness.

The features of ichthyosis which impact Carly’s diet include the rapid shedding of skin, which increases her requirements for energy, protein and fluid, and also the risk of infection, which can make her unwell and require drug therapy, which place her at risk of reduced appetite and decreased food intake.

 

A Snapshot of Carly’s Diet

Carly sent me an outline of a typical day of healthy eating, so I thought I’d go through that with you and make some suggestions in light of her requirements and food preferences. Carly enjoys eating organic, healthy food, with the occasional indulgence (hello Miss Chu’s steamed custard buns! Or maybe that’s just me…) Anyway, here we go!

First of all, yes it is great that Carly favours natural ingredients. I am a real fan of natural produce - generally speaking, the less refined the better. It’s far kinder to your body if you can recognise what you’re putting into it - anything heavily processed and pre-packaged with a super long ingredients list is generally not going to be the best choice, nutritionally.

Breakfast

Porridge - rolled oats, skim organic milk, a spoon of organic activated buckinis, and topped with home made stewed fruits (plum, apple, quince + rhubarb, small amount of raw sugar)

I’m loving Carly’s breakfast, which is so natural and full of fibre. Wholegrains like rolled oats are such an important, nutritious addition to her diet. The buckinis is made from buckwheat, and is very nutritious and easily digested by the body. It contains protein, rutin (a flavonoid) and manganese, providing Carly with a really good dose of nutrition. Carly is also getting some vitamin C from the stewed fruit, which is important for skin regeneration.

Snack

Two ryvita biscuits topped with nut butter and honey

Carly’s snack of ryvita and nut butter is very nutritious, giving her another wholegrain hit, and the nut butter….well, I am a huge nut butter fan! Going for natural nut butters, which contain 100% nuts (i.e. no added sugar, salt, oil), is fantastic. They provide healthy fats and protein, and are incredibly delicious. ABC spread is a personal favourite (an almond, brazil, cashew blend). Sweetening your nut butter toast, sandwich or crackers with a thin spread of honey or jam is absolutely fine. It’s better to add sweeteners yourself than buy something pre-sweetened – this way you can control what goes into your body and how sweet to make it.

To mix things up a bit, Carly could try avocado (which contains vitamin E and wonderful healthy fats, which are good for skin health) or hummus (which is full of protein, vitamins and minerals) on her ryvita.

Lunch

Risotto - mushrooms, chicken thigh fillet, beetroot, spinach, onion, sweet potato, garlic, feta, low fat ricotta, stock.

Carly’s risotto lunch is helping her reach her recommended 5 serves of vegetables a day (a serve being ½ cup cooked vegetables/legumes or 1 cup salad vegetables). The chicken is giving her some protein, along with a little more from the fetta and ricotta.

Other good lunches that are easy to pack for work include salad wholegrain rolls containing chicken or tinned salmon, grain salads or leftovers (make sure they are properly reheated). 4-bean mix and tinned fish are healthy, simple ingredients that Carly could easily take to work and add to a salad or have with ryvita’s if she’s running late and doesn’t have time to pack lunch in the morning. Baked beans are another easy nutritious option when you’re at a pinch (or have an old fashioned craving).

Carly hasn’t listed an afternoon snack here, but it’s important to make the time to have something. Perhaps Carly can include a daily afternoon snack of low-fat yoghurt with some fruit, nuts or a tablespoon of muesli. Yoghurt is a fantastic food, and I would really recommend Carly include more yoghurt in her diet. It’s a fantastic source of nutrients, containing protein and B vitamins. Some brands, like Vaalia, contain important probiotics for the promotion of good bacteria in the gut. This is especially important for Carly when she requires antibiotics for infections, and for the general stimulation of her immune system.

Nuts also make a great snack, as they’re full of protein, vitamins and minerals. Almonds are also high in fibre, and walnuts contain Omega-3 Fats, so including these nuts in your diet is a great idea.

Dinner

Vege curry - pumpkin, cauliflower, garlic, mushrooms, tinned chickpeas, carrot, tinned tomato, dates, curry powder from Halal butcher and topped with Jalna yoghurt.

Dinner for Carly on this day is very nutritious. Here she’s gaining the rest of her vegetable serves for the day (and probably more if the serving size is big), and she’s included chickpeas. Chickpeas and other legumes are a fantastic source of nutrients, providing fibre, protein, vitamins and minerals. The Jalna yoghurt is a lovely way to finish off her delicious meal (I’m a big fan of the Jalna brand both nutritionally and taste-wise).

Carly’s dinner is lacking a grain, so some quinoa (although not technically a grain) or brown rice would be a nice addition to the meal. Quinoa is a complete protein, containing a desirable set of amino acids. It is also a good source of fibre, magnesium and iron, so it really is a superfood. You can use it as a rice replacement, in salads or even as an oat replacement in porridge.

Oily fish, such as Salmon, Herring, Tuna (steaks more so than tinned) Mackerel, Anchovies and Sardines are a great source of Omega-3 Fats, which have an anti-inflammation action in the body and so are of benefit to skin health. Carly should aim to include these two to three times per week. Try baking Salmon steaks at dinner, having smoked salmon with your eggs at breakfast or putting anchovies in stews at the start of the cooking process (they disintegrate and you can’t even tell they’re there!)

Lean red meat will be another valuable inclusion to Carly’s diet. Aiming for 3-4 serves of 70-100g lean red meat per week will provide Carly with a great dose of protein, iron and zinc. Grilled eye fillet steak with roasted vegetables; bolognaise with beef mince; or lamb backstraps marinated in olive oil, garlic and rosemary are favourite red meat meals in my house.

Dessert

Piece of home made cake - free range duck eggs from parents, skim organic milk, unbleached flower, sugar, butter and stewed fruits as above (I cooked heaps of fruit!)

And finally, dessert! All I can say is, can I please have a slice? Carly is very lucky to have access to fresh eggs from her parent’s property (I’m also in the same position but not with duck eggs - only chicken eggs for me). I’m a big fan of fruit in my cakes too, it allows you to rely on their natural sugar instead of adding bucket of refined sweeteners. Moderation is the key, and in light of Carly’s very nutritious day of eating, a slice of this cake sounds mighty fine to me!

Drinks

Water - 4 glasses in the morning, 3x 600 ml bottles at work, and 4-6 glasses at night.

This equates to 2.8-3.3L per day, so Carly is definitely staying well hydrated. Keep in mind that Carly needs extra hydration in light of her skin condition, and that for the general population the recommendation is for 2 Litres/day (more if it’s very hot, if you’re very active and if lose a lot of fluid through sweating).

Additional Comments

There are a number of final notes that relate to Carly, ichthyosis and her dietary requirements.

1. The first is the fact that she sheds skin at a really fast rate. This increases her need for kilojoules, protein and fluid. Carly says people often tell her, “wow, you eat a lot!”. But this is because she actually does need to! Carly is within her healthy weight range, so that is a good indication she is getting enough kilojoules. Monitoring her weight is a good idea to see how she’s eating in light of her increased energy requirements, and to avoid any weight loss.

Carly’s dietary protein sources are meat/poultry/seafood, dairy, nut butter and chickpeas. She could look to ensuring she has a protein-rich snack in the afternoon (such as yoghurt and/or nuts), and increase the protein content of her dinner by including some quinoa, lean red meat or oily fish.

2. The second note is that Carly is susceptible to bloating and stomach cramps after eating some foods. She states that this can be a fairly random occurrence and can come after previously feeling fine when eating a certain food. Carly states that she eats large volumes of food, so the bloating and cramps may simply be due to an overload of fibrous foods (i.e. vegetable curry for dinner). She may benefit from smaller, energy-dense, frequent meals (which is why snacking is so important). This will help her get in a bigger variety of foods too, making sure she reaches all her nutrient requirements. Healthy snacking is the key!

3. And lastly, it is always good to be as healthy as you can be, especially when you have a chronic illness like Carly. You want your body to be in peak condition to fight any infections that may occur. Ensuring you eat enough macronutrients (protein, fat, carbohydrates) as well as micronutrients (vitamins and minerals) is really important.

For Carly, when her skin becomes very sore and dry, there are a number of foods she should focus on eating. As she may not feel like eating large volumes of food during these times, it’s important she chooses very nutritious options. Basing her diet around the following foods during these times, and staying hydrated, will help her recovery.

- Lean meat and chicken

- Fish, especially oily fish

- Dairy products (milk, yoghurt, cheese) – milk is a very nutritious and hydrating option, try smoothies, milkshakes or even milk milos

- Nuts (unsalted)

- Eggs

- Legumes

- Avocado, Hummus, Nut Butter

- Quinoa, oats and other wholegrains

As an additional note, taking pain killers (if they’re strong) can block you up and lead to constipation. It is important that when taking these strong pain killers Carly eats enough fibre and stays hydrated, to promote healthy bowels motions. Adding some bran (my favourite is Vogel’s Soy and Linseed bran – it doesn’t taste like cardboard, bonus!!) to your diet, sprinkling a tablespoon of psyllium husk on your cereal and eating 3-4 prunes are good tips to help keep you regular. Although Carly’s diet is very high in fibre as is, during times when she’s feeling unwell she may not be eating as varied or large quantities as in this snapshot.

Eating Out

Carly also asked for healthy take-away options. Well, we’re really quite spoilt here in Melbourne for delicious and healthy take-away food. As I have mentioned previously, Carly is aiming to make sure she gets a good dose of nutrients, including protein. Something like Japanese is a good option, where you can find lean meats, vegetables and rice. The only problem is that it is high in sodium so this will make Carly very thirsty – remember to drink lots of water! You can get nutritious ingredients including lean meat on Crust Pizza, and Grill’d burgers are always a favourite of mine. Apart from these specific recommendations, it really just comes down to the usual take-out rules for general health – avoiding creamy, oily, battered, fried foods and sticking with steamed, lean and fresh (generally speaking).

Having said that, Carly, we’re on for Laksa King when I get back from America, yes? ;) Carly’s diet is very nutritious, and so having the occasional indulgence is absolutely fine and is, in fact, very healthy – eating is such a social experience and much joy can be gained from it. We must not underestimate the positive benefits of these interactions on our health and wellbeing.

In summary, the areas where Carly could boost her nutritious diet further would be… aiming for more frequent, nutritious snacks (Vaalia yoghurt, nuts, avocado, hummus); ensuring she includes a grain such as rice, pasta, bread (or quinoa) and good protein source in her evening meal; ensuring she eats lean red meat in the desired portions 3-4 times per week; and eating oily fish two to three times per week."

This post is part of the Ichthyosis Awareness Month project. For all posts in this project, click here.

For Ichthyosis and appearance diversity resources, click here.