The Low Nickel Diet Cookbook & Guide: A Holistic Approach to Systemic Nickel Allergy

By Laura Duzett

The perfect guide for people with nickel allergy who need to make a low nickel diet as simple and stress-free as possible so they can reduce their systemic inflammation and such symptoms as dyshidrotic eczema, IBS, GERD, endometriosis, fibromyalgia, and chronic fatigue. 

Systemic Nickel Allergy is a well-established condition in Europe, but remains unknown and under-diagnosed in the United States. 19.5% of adults and 25.6% of children have been found to be allergic to nickel on the skin and a large portion of those are believed to be allergic to ingested nickel found in unfiltered water, processed food, and a large amount of plants. The research has consistently shown that the most effective treatment is consuming a low nickel diet of fewer than 150 micrograms of nickel per day, which is an incredibly difficult task to achieve with existing resources, and that is why this book was created by a nutritional therapy practitioner who suffers from this condition and a board-certified dermatologist who specializes in it: To make eating a healthy version of the low nickel diet as easy and successful as possible.


This book provides:

• Over 140 gluten & grain-free recipes that list nickel amounts per serving so you don't have to calculate it
• Low, medium, & high nickel food guides
• A 125+ ingredient reference showing nickel in household measurements
• Three different approaches to starting a low nickel diet
• Strategies for holistic support of your healing journey supported by research
• A 2 week meal plan

• Language: English
• Publisher: Laura Duzett
• Release date: Oct 13, 2023
• ISBN: 9798223942979

Book preview

ABOUT LAURA

Hi, I’m Laura Duzett, and I am an osteopathic medical student and certified Nutritional Therapy Practitioner living in Las Vegas, Nevada. I am passionate about the impact of nutrition on health, and have seen first-hand what the body can do to heal itself when the right foods are removed or added to someone’s diet.

My first career was in program management in Silicon Valley, and during that time I used a variety of dietary changes to help myself reverse pre-diabetes and obesity, and later to recover from a mild traumatic brain injury. These powerful experiences led me to change my career; starting with nutritional therapy, and then expanding my knowledge into medicine.

From my years of experience helping people with their nutrition, I know how incredibly hard it is to make dietary changes no matter how necessary they are, and when it comes to the Low Nickel Diet, it is also very complicated. When I was diagnosed with Systemic Nickel Allergy, I quickly discovered how few resources were available. That is why I started this project in 2019; I wanted to make it as easy as possible for the average person to effectively and comfortably imple- ment this game-changing diet!

Some caveats . . .

I am not a chef, so do not expect anything gourmet or fancy. I’m sure many of you will create even better versions of these recipes. I hope this cookbook serves as a jumping-off point to inform and inspire your own fabulous creations.

I am not yet a physician. This book is not intended to be used for diagnosis or treatment. I am sharing with you my experience and the research as I find it. Please seek a physician’s guidance in your diagnosis and treatment plans.

MATTHEW ZIRWAS

Matthew Zirwas, MD, is an American Board of Dermatology-certified physician. He is a nationally known expert who has been specializing in contact dermatitis, pruritus, 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, co-authored the 7th edition of Fisher’s Contact Dermatitis, and has given over 200 national continuing medical education lectures to his peers.

His passion is figuring out the real, practical, take-home messages that we can get from the medical literature. Not just reciting ‘the data’ or what the authors said, but synthesizing it and putting it in the context of how it can help patients. Basically figuring out ‘what this study REALLY means’ and ‘how does this connect to what we already know’, then explaining it in a practical, relatable, entertaining and memorable way.

In Dr. Zirwas’s free time, he enjoys spending time with his kids and cats. In that order.

INTRODUCTION: A STRATEGIC MARRIAGE

Let’s begin by pointing out the obvious: The standard lists of low nickel foods rank by nickel content, not by health promotion. Eating from that list with no other consideration than the nickel amount will allow you survive, sure, but will it help you thrive?

This conundrum is what I faced as a newly diagnosed patient and is the reason why I am writing this book; I want to demonstrate that simple, delicious, and healthy meals can be created from that list while also avoiding low-nickel foods that may work against your overall health goals.

As you flip through this cookbook you may notice some common recipe types missing and see some ingredients that are unf miliar. I want to make sure I address these differences and assure you that I did my best to offer alternatives for those who have limitations in accessing those ingredients or who approach nutrition differently than I do.

My decisions about what foods to emphasize and discourage in this cookbook are based on the following biases: my personal experience with this allergy, the results I have witnessed in my nutrition clients, and my understanding of the pathophysiology and existing research.

As an osteopathic medical student, a holistic, multi-system approach to healing is a large part of our tradition’s heritage and contribution to modern medicine, and my philosophy reflects that. At this time, I believe that in addition to removing the stressor of my allergen (nickel), avoiding digestive and immune stressors like gluten, grains, sugar, processed foods, and high carbohydrate intake may improve my body’s ability to heal itself and thrive more effectively than just avoiding nickel alone.

Current research indicates that a relatively large proportion of nickel-allergic people also suffer from other systemic conditions that have standardized guidelines recommending diet as the primary treatment, like Irritable Bowel Syndrome (IBS), obesity, metabolic syndrome, Celiac disease, and gluten sensitivity.¹ We do not yet know if there is a causal direction between these conditions or if they develop independently, but there is evidence that addressing one can help address the other, particularly when it comes to promoting a healthy digestive tract with low intestinal permeability so as to allow less nickel through.¹-³

Therefore, my nutritional approach in this book reflects a strategic marriage of the low nickel diet and therapeutic diets recommended by those guidelines (Low FODMAPs diet for IBS,⁴ and both the Mediterranean diet⁵-⁷ and lower carbohydrate diets for metabolic syndrome and obesity⁸,⁹). Though I have seen this strategy work very well, please understand that the effectiveness of this combined approach has not yet been researched nor demonstrated in randomized controlled trials for individuals with systemic nickel allergy.

Plenty of people do just fine eating gluten, grains, sugar, and processed foods, but the resources available already cater to those people, so I have chosen to make this book a resource for people, like myself, who wish to try eating low nickel without them. You can easily swap ingredients or add these things to the existing recipes, and I try to indicate those opportunities throughout.

MY STORY

My first outbreak was Thanksgiving of 2016 while doing dishes; I noticed a painful and itchy patch of skin on the ring finger of my right hand. The patch eventually went away just to be replaced by another shortly after, except it was a bit bigger. The next time, even bigger, etc.

This began to follow a cycle: It would start with itchy patches of skin that became little fluid-filled bumps that would eventually burst, becoming painful open sores. Then the sores would scab over, and the skin would begin to heal. As soon as I’d think I was in the clear, the cycle would start again.

My primary care physician diagnosed me with dyshidrotic eczema (DE) and contact dermatitis. He prescribed me a cream, which sometimes helped, but didn’t stop the cycles. I tried another two types of creams over the course of several months to no avail.

It got worse and worse until Summer 2017 when I had the eruptions over 2 ½ of my fingers on my right hand and it was slowly spreading onto my palm. I had to have all three fingers bandaged most of the time and lost most of the use of my right hand.

On top of this, I began having terrible eczema breakouts all over my face and body: around my mouth, eyelids, cheeks, neck, back, stomach, and my wrists. I was itching and in pain all day, and it was keeping me from living a normal life. I could only get relief from baths and covering myself in all sorts of ointments and lying there without moving for hours.

I was finally referred to a dermatologist, but the appointment wasn’t for 2 months. I was desperate for relief. I began researching DE on my own. I found a few Facebook groups that educated me on several causes of DE, which included nickel allergy and common chemical additives in personal care items.¹⁰

Not wanting to change my carefully cultivated brain-healthy diet, I started by removing all products with common chemical irritants. After a few weeks it wasn’t making any difference, so it was time to test the nickel hypothesis. When I found a list of high nickel foods, I was shocked; I was eating a lot of them: nuts, seeds, legumes, and chocolate! Many of these foods I considered healthful, but for my unique situation, they were potentially harmful.

I began eating as low in nickel as possible. In less than a month, my skin was finally healing, the outbreaks were lessening in intensity, and after about two months, the cycles ended. Shortly after, my dermatologist confirmed the suspicion that I likely have a systemic nickel allergy.

It’s been six years since I began restricting nickel and I don’t have to eat as carefully as I needed to in the beginning. I’ve been able to eat chocolate and nuts here and there without problems unless I eat it on several back-to-back days, or I am generally not taking care of myself (my overall wellness is low and/or my stress is high).

From time to time I will get an itchy patch on my right hand, but as soon as that happens, I know what to do to keep it from escalating, and now you will have a toolbox to draw from in order to create your own perfect protocol!

WHAT IS SYSTEMIC NICKEL ALLERGY?

Nickel is the most common metal allergen in the world. It is used in manufacturing (particularly in stainless steel) and the formation of everyday items such as jewelry, electronics, cookware, and personal care items. It also exists in the water and soil in varying amounts (it is particularly high in volcanic soil), so it can be taken up by plants, making its way into our bodies through digestion of food or inhalation of plants and toxins like when smoking cigarettes.¹,¹¹ It can also be found in medical implants and dental fillings.¹

The above are all potential routes for nickel to interact with your immune system and cause a hypersensitivity to develop. This sensitivity is most common in women, and prevalence has been on the rise in North America, from 14.5% in 1992 to 18.8% in 2004.¹² In Europe, adult incidence is estimated between 8-19%, and 8-10% in children.¹³

HOW DOES THIS ALLERGY MANIFEST?

Nickel Contact Dermatitis: Cutaneous (skin) reaction at the site of nickel contact.

Symptoms: dermatitis, itchiness, eczema where contact was made.

Prevalence: It is estimated that up to 19.5% of adults and 25.6% of children have nickel contact dermatitis with 5.7% to be asymptomatic.14

Systemic Contact Dermatitis (SCD) or Systemic Nickel Allergy (SNA): Cutaneous reaction due to ingested or implanted nickel.

Symptoms: Dyshidrotic eczema of the hands and feet (the most common symptom), allergic contact dermatitis, eczema, urticaria, psoriasis occurring commonly on the hands and elbows, and sometimes on the feet, face, and around the mouth.

Prevalence: We do not know the exact amount, but many nickel-allergic patients experience cutaneous symptoms in places other than nickel contact after taking an oral dose of nickel.¹¹ In fact, there have been studies showing people who don’t have reaction to a nickel patch test can have a reaction with a high dose of nickel consumed in one sitting.

Systemic Nickel Allergy Syndrome (SNAS) or Nickel Allergic Contact Mucositis: Cutaneous and/or extra-cutaneous symptoms due to ingested nickel. The existence and specifics of this syndrome is under debate due to the complexity of identifying causes and effects of the extracutaneous symptoms.

Symptoms: Systemic symptoms which include but are not limited to: The cutaneous symptoms listed above, Irritable Bowel Syndrome (IBS),¹²,¹³ chronic fatigue, obesity, endometriosis, GERD (heartburn), celiac disease, nausea, vomiting, asthma, headache, thyroid conditions, burning mouth syndrome, and fibromyalgia.¹⁶–²³

Prevalence: 20–30% of Nickel Contact Dermatitis patients.²³

Common comorbidities: IBS, Celiacs disease, gluten sensitivity, obesity, and metabolic syndrome¹, ²³–²⁸

HOW DOES THIS ALLERGY DEVELOP?

Though the exact mechanisms for the above conditions are complicated and not fully understood, a very simplified version is that your immune system, which is always looking to eliminate harmful invaders, mistakes nickel as an enemy. Nickel can come through the skin due to an injury, a weakened skin barrier, or during sustained contact. The local immune cells interact with it. Too much interaction may cause overreactivity. Wanting to be as effective as possible, the immune system creates other cells whose sole purpose is to find nickel and eliminate it. These cells release mediators (like histamine) which kick off processes meant to protect your body but come with a variety of uncomfortable side effects like itchiness, swelling, eczema, etc. Later, these cells may see nickel in other locations, like your digestive tract, and create inflammation there while potentially also mounting the same defense on your skin or elsewhere, even though there is no nickel touching that location!

In research, differing combinations of immune cells have been identified, possibly explaining why there are a variety of reactions and severity that can be experienced.²⁹ Additionally, we have found each nickel-sensitive individual has their own nickel threshold, meaning that if you stay below it, you can potentially avoid those troublesome symptoms. The standard recommendation based on experimental data is to keep your nickel intake below 150 μg a day.¹³, ³⁰–³³

Therefore, reducing the amount of nickel you contact and consume reduces the amount of nickel you present to your immune system, which reduces symptoms. It may even be possible to lower the number of cells running around looking for nickel, too. The body is always trying to conserve energy by shutting down immune cells it doesn’t need. For some people, that means reducing nickel exposure can also reduce the number of immune cells looking for it. This may result in your body becoming less sensitive to nickel, and you can start eating higher-nickel foods without the trouble you had before. This was the case for me after about 4 years of eating a low nickel diet most of the time. This process is called desensitization