Getting to the Root Cause of Eczema With Dr. Sheila Kilbane

Podcast introduction and guest background 0:00

Hello, everyone. Welcome to the Thyroid Pharmacists Healing Conversations podcast. Today, we're going to be talking about the root cause of eczema. I'm your host, Dr. Isabella Wentz, PharmD, your thyroid pharmacist. And today, I am joined by somebody who is, in my humble opinion, the world's top eczema expert, Dr. Sheila Kilbane. She's the reason that my little boy is exima free. And I just really, really appreciate the work that she does in the world. Welcome, Doctor Kilbane. It's so great to have you here.

Isabella, thank you. it is my pleasure and you are extremely kind. Thank you for that great, that lovely introduction. I'm gonna give you a little bit of background. So Dr. Sheila Kilbane is a board certified pediatrician specializing in integrative medicine with a mission to transform pediatric healthcare by addressing the root causes of chronic childhood illnesses. She combines conventional medicine practices with evidence-based nutritional and lifestyle interventions to help children achieve optimal health.

In her North Carolina practice, Infinite Health, Dr. Kilbane developed the Healthy Kids, Happy Moms program, a seven-step approach designed to heal and prevent common childhood conditions such as eczema, asthma, allergies, reflux, and recurrent infections. It is really focused on the significant role of nutrition and lifestyle in children's health, as well as getting to the root causes. She's also the author of the book Healthy kids, happy moms, Seven Steps to Heal and Prevent Common Childhood Illnesses.

We're going to link to that in case you wanted to check that out. I was really excited to endorse that book, and when it came out, I said, we need to get this out in everybody's hands. She's an active educator and speaker and just so, so happy to have you here with us, Dr. Kilbane. Well, thank you. And when I do any talks or anything, we have an amazing team. So it's never just me. We have incredible, actually, a pharmacist. I wish everybody had access to a pharmacy. Deb Allen, she helps create the programs that we do and does a lot of the research.

so I always want to just make sure that I acknowledge everyone who's involved in what we Yeah, I've had the pleasure of meeting your incredible team and you have really dialed in not just how to solve like complex patient cases, whether that's eczema or asthma and really preventing that that march from symptom, you know, starting with one symptom and getting into other types of illnesses as you go, but also dialing in the patient experience. So how to support a patient on their journey. I know when we started working with you, I was a very, very overwhelmed sleep deprived mom with a Very, Very itchy little boy.

And I had tried a lot of things and I tried working with some local practitioners, but my son was still having a lots of eczema symptoms. And within working within just a couple of weeks, I remember his ectoma was like 80% gone and instead of like, you didn't recommend like an intense elimination diet. He was already like a picky eater and so I was, like I don't want to eliminate more foods You gave me ways to soothe him so that we could actually feed him more foods. And I think I sent you a message where I'm like, he gained like 30 new foods since he started making some of these root cause recommendations on how to address eczema.

Yes and that makes me so happy even remembering all of these things because it was so fun to get your messages about this and I also because we use the best of conventional and integrative medicine when we're treating eczema and we work from the outside in and the inside out and a topical that was developed by an amazing dermatologist out of South Africa, Dr. Aaron. Using his topacle as a tool in addition to the integrative process is what allows us to have this It's these improvements on steroids.

I mean, not against supports, but an improvement that they're so fast, and when we use them together, it makes such a big, long-lasting difference so that when stop some of the topicals, we don't keep getting the flare-ups. It's been really incredible to see you can take, I guess, what I would call more of a conventional medical approach where you would use a topical approach

Why eczema needs a root-cause approach 5:00

with that integrated functional medicine approach. I know when I went to pharmacy school, it was very much, oh, like aquaphor and vana cream and topically steroids. Then when I trained in functional medicine, a lot of it was like, just work on the gut, and here we're trying to do all this gut work with my then slightly under two-year-old, but he's so itchy. A lot the topical things we were using were causing essentially the itchiness to get worse as well as some of that eczema rebound when we would stop using them.

But I love that you combine both approaches so you don't get that rebound, right? We have to do that multifactorial approach because with eczema, when it is so itchy, if we don t address that and we do not address the histamine, we that itchiness, the kids have bacteria under their fingernails, just the act of itching disrupts the skin even more than what it is already disrupted, right? And so eczema is, it's a dry, itchy, scaly, patches that we see on the skin and it can be all over the body. It classically will be on, you know, the insides of the elbows and behind the knees, but it significant how bad it is, right?

There's a wide array. Some kids just have it really mild and we don't have to do a whole lot to shift. some kids have a much more significant case of it. And what I had been seeing is that in integrative and functional medicine is families would come to us and they had taken so many foods out of the kid's diet. because that is how we learn it, is if the gut is inflamed or leaky, that's going to create the skin issues. But really, there's newer research that shows when we start to get the scan healed and address the dysbiosis of the skincare, so that means all of those microorganisms that we have on the skins, just like the microorganism that are on that gut, They talk to each other, they impact one another, and it's more like a two-way street versus take out all the foods that could potentially be triggering inflammation and then the skin will get better as we have to do the two pronged approach.

Yeah, I think that's such a wise approach. And I remember reading an article from the University of Chicago where they talked about how the food tolerance is related to the skin barrier, like when you have a very permeable skin peanut butter out of a jar and they get that peanut under their fingernails and start scratching their skin, some of that can get into their immune system and then they can become sensitive or even have allergies to things like peanuts. I just think it's so fascinating because in functional medicine we talk about leaky gut and intestinal permeability, but we don't talk how important the skin barrier is for managing our immune systems as well.

No, right. Dr. Peter Leo, he is up in Chicago. I don't know if he did that original research, but he's the one who was doing a talk that I first heard that, and he talked about if the peanut hits the skin, that can actually trigger the food allergies and food sensitivity. And I was like, oh my gosh. Because it also, when you think about it, even the lotions that we put on. At different times, we've done mentorship programs. And at one point, actually, one of the practitioners in our program who does a lot of work with eczema, she had families who were using was a goat's milk top cream, you know, like a nice organic goat milk based cream.

It was either that or coconut oil maybe. And then they were developing food sensitivities to what was in the topical. So that's also why we're really careful of what we are putting on the skin is because we don't want to trigger. That's why innocuous. It's not going to trigger things. And it's always, because it can feel super overwhelming, right? When you're really tired and you don't know what to eat, you know, what's triggering them. You don t know how often to bathe them, and that's where in our practice, even the way that we make an Excel spreadsheet for people is we just have to break it down one thing at a time.

So usually that s all we do at the beginning, we use an antihistamine and then we start the topicals. Then once we get the skin under control, then, we move on from there. I think histamine is such an important part of the puzzle here. Eczema is part what we call the atopic triad, which you alluded to earlier, and it's eczima, asthma, allergies. and often kids with eczema will go on to develop asthma and allergies and asthma. And about anywhere from 50 to 80% of kids, with Eczima or asthma also have allergies.

So it's not only, and that's environmental allergy. We know that with, I'm throwing out a lot of stats here, but with Exzima, we know about a third of the time it can involve food allergies or food sensitivity. So that's not all of the time, but we need to pay attention to that as well. And it's the two big culprits are dairy and eggs. It can be other foods and it doesn't always mean those are the foods that are involved, those just two of big triggers. And when it comes to environmental allergies, those are also a big issue.

So once we look at, we're always identifying those things is we want to kind of put the fire out while we are figuring out what other pieces of the puzzle we need to address. Does that make sense? Yeah, I think it makes a lot of sense. I'm just like reflecting on my own journey with with my son Dimitri. It's like sometimes when you try to like look for all the root causes and the triggers that can be really, really overwhelming, especially when You have a child that wakes up all night and very, very itchy.

And so what are the things that you do to, like, soothe that child right away and help them be less itchy, help feel better and so then you have a little bit more bandwidth and perhaps the more brain space to like investigate what else might be going on there. Now I think you taught me you had this amazing analogy of eczema and just A to P in general and you described this bucket that overflows and a lot of times people think it's genetics. My mom had asthma, therefore I'll have asthma. His brother has asthma therefore you know, he's going to have asthma.

Can we can we talk through some of like, I just love your bucket analogy. It's just fabulous. Thank you. So I'm and I the bucket analogy was something that and i'm going to just show you a picture so I use it a lot in my book because I think it is it's really important to help families understand what's going on because i think when you understand the why it''s a aot easier to execute because it it'a lot of work that we're asking families to do. It's not just one and done, right? We're going to use these things and then we're gonna gradually build up our cellular health and get the full thickness of the skin to heal.

So when it comes to that bucket of inflammation, we've all got our underlying genetics and it's the way that our genes interact with food, environmental allergies, and environmental toxins infectious diseases and stress, right? And stress can be physical, it can emotional. All of these things contribute equally. So we can't just say, we've got our genetics and that's what the outcome is going to be. What we do is we say, okay, we have some underlying genetics, and maybe we got a predisposition toward these allergy type illnesses.

But what we can do, is decrease our triggers of inflammation and then we optimize our DNA, our genetic expression. And by supporting cellular health, we always are talking, if we think about everything in our practice, on the cellular level. We need good healthy cell walls, because if we're talking about the health of the skin and all of those layers, that is created, right, of millions and millions of cells. So we need healthy cells walls. And that also goes with the GI, with a lining of gut, is we really need really good, healthy-cell walls Then we need strong digestion so that we're breaking

Histamine, allergies, and the eczema itch cycle 15:00

down and absorbing the nutrients into our bloodstream, so the nutrient go where we want them to go. but it's never, we can never be perfect in all of those areas of the triggers of inflammation. And Demetri is a great example because we, can only do the best we when you have a child who's on the right, he's a smaller in build and we don't want those kids to lose any weight. If they're particular and say we're gonna take out all these major food groups, We don't want these kids to lose weight because we've got to think about brain development, physical development right, muscular development fine motor development.

And so we do it, we. Do things very gradually and we just do the best we can in each area and again, right? It's food, environmental allergies, environment toxins, infectious diseases and stress. We just take each of those down as best and you get this really beautiful, transformative process, and it's almost like the light comes on again. It's these kids when they feel better. We just had this again recently with a one-year-old, he was digging and clawing, it was gut-wrenching to see and really within about 36 hours of being on the topical and continuing the antihistamines that he had been on, he was like a different kid.

You just look at the eyes. Of course, parents were over the moon and we, in our practice, all of us get extremely excited at all these little wins because it's life-changing when you're not up all night scratching. you as parents can get off of Dr. Google because you can see the results and then we just proceed step by step. Yeah, it was really, really game-changing. So Dimitri, I was always gluten-free and dairy- free and organic with him. It's not like he was eating trash McDonald's or something every day, but he a bit of a picky eater.

I remember coming across a book on eczema and it had this really extreme elimination diet that I read the book and I just started crying because a lot of the foods on the elimination diet, it was like 16 foods and like half of them he didn't like. And I'm like, so I could feed my little baby eight foods. That's when I thought like there has to be a better way. The amazing thing, we mentioned a little bit about the topical skin barrier and that's a big game changer because you can actually be less sensitive to foods when you fix your skin barriers.

But there's also that histamine component where certain foods might cause reactions because you have a histamine overload in your gut. Is that right? Exactly. And what happens is when we've got a microbiome on our skin, and kids, adults, people with eczema have higher bacterial count, including staph bacteria. and that staph secretes something called a delta toxin. Part of what creates the flare-ups is that the staf bacteria is secreting this delta-toxin and it's creating the skin flare, it is creating that gut inflammation.

All of that also creates more histamine in the body in addition to if you're eating foods that you are allergic to or you getting exposed to environmental allergies. And when the histamine levels are up, it not only creates watery itchy eyes, but it's itchy skin, and it contributes to the leakiness in the gut, so that inflammation that we see in Histamine also acts as an excitatory neurotransmitter. That's part of why trouble falling asleep, trouble staying asleep mood swings when the skin is out of control.

We can see this also with a lot of other issues is during the spring and the fall when allergy season acts up, if we don't have the histamine levels well controlled, their moods can go up and down in the spring and the fall. One of our first go-tos when we hear things like that of meltdowns and irritability, trouble sleeping is we're going to talk about histamine first and foremost. It's just so fascinating because I think a lot of people think of histamine as something that's related to allergies, right?

But it's actually a neurotransmitter as well. And so that can impact irritability and even make kids less hungry and not sleepy. I remember Dimitri, he was always very talkative. He was like, mommy, I am never tired and I'm never hungry. And once we got his eczema under control, like he was so much more calm overall and his his appetite got better too. It's just so fascinating how it's all connected because I think I've talked to some parents and have seen some parent that are like, oh my gosh, my child is a picky eater.

They have eczema, they have asthma, there are really irritable and then they had all of these other symptoms going on. What is going here? When you draw a Venn diagram and what's in that middle, it is histamine, right? It's such a profound shift when you put all the pieces together. And there are, because a lot of times we're always, like I will see families after they've been to a lotta different practitioners, and so sometimes parents are very reluctant to use whether it's a regular antihistamine, whether its prescription, or even some of the topicals that we use, but it's we have to put that fire out and that's part of controlling that histamine is putting out the fire so that we can begin to heal because otherwise we're chasing our towels and one of the best examples I can think of with histamines is that, we just keep chasing or towels if we are not able to bring the histamin levels to happen.

So I know there's a few different ways to bring histamine levels down. So let's say you can take a Benadryl over the counter, you could take quercetin, and you take some DAO enzymes. this answer, but do you have some go-tos that you might use as a prescription or perhaps to parents that they're listening at home, how they can help support their children in reducing histamine levels to start that healing process? Yes, absolutely. In our practice, we use a compounded antihistamine, it's called catatophin.

But at home, what you can use is just regular diphenhydramine. And I do love, there's a company called GeneXa, and they make a really clean dipenhydromine, which is the active component of Benadryl. Or you could do a dye-free Benidryle. We're not gonna say, get on this and take it forever. we're gonna to say let's get this a few days, maybe a week, let see how that is. Dye-free Zyrtec is one that you can use during the day. At the beginning, we may be doing a stronger one because the Benadryl is more sedating and it can help the kids sleep.

Then we'll do the Zyrytech in the morning to control it during day, and so we will use that at the begining. If you're at home, always talk to your pediatrician, but that's what I do in practice. Then eventually, we shift so that the kids were using more of the versitin, stinging nettle, vitamin C, some of these other more natural products that help control histamine. The DAO enzyme is another. We don't use that as often. That can be helpful. I think because we start with a stronger, the prescription antihistamines, we're usually able to move on more toward the quercetin and vitamin C along with the anti-inflammatory fats.

All of these are going to help create stable cell walls so that the histamine doesn't as easily get triggered out of the cell and systemic to where it creates all of the issues. And that makes so much sense that I know, speaking from personal experience of having hives, my aunt was like, here's some quercetin. I was, I'm going to pass on this, let me get some Benetrile because it's going work so better. But the goal is not for kids to be on these forever. Because I sometimes people are concerned about utilizing antihistamines long-term.

produce sedation long-term. Of course, in the elderly, this is not recommended because of cognitive issues, but the goal is this going to be one step.

The bucket analogy and inflammation triggers 25:00

Then we're also going move on to additional steps where we figure out what to do with the skin. Now, I know you use a protocol called the ARIN protocol. Could you tell us a little bit more about that? Why does that work so well and perhaps if there's things people can do at home too? So Dr. Aaron, who has become a dear friend, I just adore him. Brilliant, brilliant dermatologist out of South Africa. He's in his eighties now, and we've done some talks and things that you can find on our website if anybody is interested in hearing more.

So he started recognizing years ago that there was an infectious component to eczema and this staph. So, he basically figured out and treated what research is now showing us that that staph bacteria is part of what's creating the leaky gut and increasing, worsening the food sensitivities and the foot allergies. So the topical is it's a small amount of a prescription antibiotic, a soft mall amount, of the prescription steroid, and then a whole lot of vanny cream or, you know, a moisturizer. He recommends vany cream.

And so it's a very dilute, tropical, and you do, it is the frequency of applications, right? We start off with four times a day for a week, then three times a day for a week, then twice a days for week and then once a date for weak. And then at that point, sometimes often we need to do it once or twice today for several months until we're able to work through the gut part of it and the cellular health, right? So we are always strengthening the cell wall, making sure we've got a nice mobile cell while that nutrients can go in and out of that.

we've got to bring the inflammation down in the gut, because when the got is very inflamed, like you can look at your kids, whether they have eczema, asthma, allergies, is they may have kind of pale skin, dark circles under their eyes, they might be mouth breathing and snoring. and they may have constipation or loose stools, and all of those things mean they have some inflammation in the gut. So they're not breaking down and absorbing their nutrients as effectively and efficiently as they could be.

And this is, again, where Deb Allen, our integrative pharmacist, she is the mother of 20-year-old triplets, The method that we use, we developed together and the supplements, the way that do it was how she did it with her babies when they were premature triplets. so she had to do things very slowly. We really always try to only change one variable at a time. Yes, we do do the antihistamine and the Dr. Aaron, but as we're using the Doctor Aaron and getting that started, the goal is not to be on it long-term.

The goal was to use it and get the gut and cells back to where they need to figure out whatever triggers of inflammation there are, and then eventually wean off of it. But when you think about, I always talk about eczema similar to asthma is with asthma, we know the research has been out for years that we want to prevent these big asthma flare-ups because when do that, it's a lot of inflammation in the lungs and that can ultimately cause something called remodeling in lungs. So if you have a lot of asthma attacks and you're having to do oral steroids, when you are 14, 15, 25, you may not have the same lung capacity that you had when were younger.

And so with eczema, it's all about getting it under control and then keeping it out of control. We don't want to Sometimes people don't want to use the topical because they want get off of it as quickly as possible, but we temper that. We say, we've got to get that full thickness to heal. Each time it flares up, it's like a sprained ankle that we keep respraying. So we just have to keep that inflammation under bay. I really appreciate you sharing this perspective because I know some people, myself included, are skeptical of using steroids on eczema because they can thin your skin and they cause rebound.

But with this protocol, you're doing a tiny, tiny dose of steroid. in a moisturizing cream base and you're also adding the antibiotic which heals the staph right so it heals kind of like what's triggering the eczema and your also not going to be on this forever because then you are going be doing the lifestyle changes and the gut work But you're just really calming down, you know, first you are calming the histamines, but you also are coming down the skin with this protocol and it's very, very effective.

Now, I know that this is something that is a prescription item. Are there things that you recommend for for patients if they perhaps don't have access to a prescribing pediatrician that is well-versed in this protocol just yet? Yes, absolutely. We have what we call our eczema jumpstart bundle, and we use a topical called briotech, which is it's hypochlorous acid. Again, I keep referring to Deb, but Deb had found this during the pandemic because we wanted something natural that would have antiviral properties.

This hyprochorous is something that the white blood cells make. It's completely natural, it doesn't sting, and it was originally developed to help patients with burns. If it's extremely severe eczema, you should be working with a practitioner. But if it is a more mild case, this may be plenty to work through it. There are a lot of companies that have ultimately realized this. It's marketed in a lots of different ways, but the one that we use in our practice because of the purity, it's called BrioTech.

We use that and we do it the same. You'll do four times a day and you can spray that everywhere. you know, can spray it on the diaper area. So we use that along with the, it's a manuka honey. It's an organic manukah honey cream that we used topically. And that it is really moisturizing. it also doesn't sting. Then we start a gentle probiotic and then a digestive enzyme. But in terms of topical, that's what we us to recreate what the Dr. Aaron does. I love that, and thank you for sharing that. And I know you provided us with an eczema guide that goes over how to use that topical briotech.

So it kind of works a bit like an antimicrobial along with the manuka honey to address that staph infection. This is something that people can order on their own. If the exima is mild enough, they can utilize that And that's over SheilaKilbane.com slash eczema guide where people can get more information on that. Is that right? Yes. Yep. Exactly. Um, let's talk about some of the lifestyle changes. I know that there's a lot of controversy. more red, more inflamed, and what else was there? Baths. How often do you bathe kids?

Do you bath them all the time? None of the times? Bubbles? No bubbles? Could you walk us through some of these? And it's interesting because we don't usually get into this in a huge amount of depth because when you start practicing this way the skin clears up so quickly again it said it clears quickly but it takes a long time in order to to get that full long lasting healing. But in terms of baths, we always wanna use a gentle organic soap. And really what I always say is wash the critical areas.

You don't necessarily have to be washing the whole body. We always just have families, however they've been bathing, whatever the routine is, whether it's daily, every other day, four or five days a week, that's completely fine. you just stick with what you're using The other aspects of that is to be cognizant of your water. We have had kids where some areas may have higher, the water quality might be different coming out of the faucet. There might be chlorine, there are things that can affect the skin.

Using antihistamines and the Dr. Aaron protocol 35:00

Some water is harder than other water, which can be more drying. We do have some families that need to use a water filter. There are a lot of different options and you can get things are fairly reasonable that will allow you to use filtered water if we need to that for a little while. Most of the time, those things are temporary until we get on the other side of this skin, but you really do want to be cognizant of, the water for bathing and for drinking. So then in terms of detergents, that's always, we want do something that is gentle, it doesn't have all of dyes, all of the, you know, when you look at most detergents, like if it's dark blue, if its got a strong color, there's going to be an artificial dye in that.

And we not only don't want the artificial dyes in our stomach, but we don t want them on our skin. So there are absolutely more gentle, If you can do an organic brand that also cleans your clothes, That would be ideal, but something much more of a gentle. And we have a couple of recipes that you can use borax to make your own detergent. But most of the time, when your kiddo is up all night scratching, to ask a mom or in a dad to a detergents is all makes it clear. There are a lot of brands that are nice and gentle, Yeah, thank you so much for sharing that.

I think the idea here is sometimes, I know you want to do things the right way as a mom, and sometimes you can get really carried away where you are like, no bubbles, know this and know that, but really when you get to the root cause, the children's skin can actually transform. I know for Demetri, I remember we were playing with like dish liquid soap and that can dissolve, that could impact the skin barrier and he was going to swim lessons and all of these things where we kind of paused a lot of the things and we did like laundry detergent makeover where went through and bought soap-based Laundry soap and like washed all of his clothes in it to make sure it wasn't affecting his skin and it was helpful.

But once we got to the root cause, it's like he you know, I could put whatever on his. Skin and he could swim every day and, like, rub himself with whatever and. He doesn't have eczema. It's just like it transformed so. I think it's something to consider is like, there's really there are things you can do on a temporary basis that can help, but don't get stuck there because sometimes it is, like you remove all the foods and you try to keep your kid in a bubble, But that's not the answer. You want them to have like resilient skin, right?

Yes. Yeah. And I just want it. That's a good example of sometimes we miss the forest through the trees is we're micromanaging all these details, but we are missing the staff, the gut health. And one of our patients recently, a teenager, and the mom sent a message and said, you know what, she was able to go on spring break. She was at the beach. She swam in the pool. she swum the ocean and the which of course is makes me so happy and she said she wouldn't have even gone to do that stuff last year because she she was embarrassed by how her skin looked and She knew all of those things would have flared it up.

So it's a really It's it just a that transformation of the skin is is really important with their resiliency for tolerating these activities that they weren't able to tolerate before. Yeah, it's been a game changer and for Dimitri his favorite thing is swimming like that's his favourite sport or whatever you want to call it. And he loves it so much. He's really good at it like his swim coach was like, let's get him on a swim team and it said like 6am so I don't think it can happen. But, but yeah, for a while, I was like, okay, we can't put him in the pool.

We can do swim lessons and that's just opened up a brand new world of possibilities for him because we don't have to worry about his skin, right? And that is how you know whether it's asthma, eczema, allergies is you have a much, when you start down this path, usually You have a pretty, you're kind of walking on a tight rope and anything that you do outside of that strict routine creates the flare up. And so what we do is we just get a much wider plank that the kids can walk on so that can veer off and you don't have to live in a bubble.

You can do a lot more without having these flare ups. Yeah, it's been awesome because it opened up our world so much. And I mean, this was, I want to say, you know, four years that he hasn't had eczema. I'm trying to remember the exact date, but it has been amazing because his skin just, is transformed within a few days. Once we did some of this gut work, right? You are the queen of gut health and it was so game changing the work that we do. Can you walk us through some of the things that you do with kiddos to support their gut and maybe that gut eczema connection?

Yes. Yes, so as we talked about earlier, we've got right back all of these microorganisms on the skin and in the gut, and they're talking to each other and they each play a role in the health of the other. With our microbiome and our gut, the diversity of that bacteria plays a big role and are overall immune system. The way we synthesize vitamins, they way absorb nutrients, that way synthesized neurotransmitters, which are our dopamine, our serotonin. We think about it like a garden. We're weeding the garden and we're not going in.

In conventional medicine, a lot of times what we do is we go in and kill things. But what were doing is were saying, let's make sure that we've got the right fertilizer. Fiber from food is really our big tool. vegetable, nuts, seeds, vegetables, fruits, those foods contain fiber, and that feeds the good healthy bacteria in the gut. We use very specific and targeted supplements in a very-specific order. I write about that in my book, it's you do one thing, and we start to shift the terrain of the gut.

And that's also where that work with Deb Allen, how she put things together with her children, that is the path that we're using when it comes to these supplements. at the beginning. So we're using things to start to change that makeup. And a lot of the bacteria, once you start shift that, the good healthy bacteria feeds the other good healthy bacteria. We start to just shift that balance while we get the skin clear. Ultimately, it's just like creating that good garden. One thing I will say too is what we see is it We start with a really gentle single-strain probiotic.

We've seen kids that will start either with big strong multi-species probiotics or a different one. One called Saccharomyces boulardii is a good example. If we introduce that too early in the process, that can trigger a flare. It may be a species that we need to add later in, but if we do it too quickly, it can cause the skin to flare up. So it's definitely a process, but if you're getting started and you are at home, I write about all of this in the book and the eczema guide walks you through it, the Eczemer Jumpstart Guide.

Yeah, it's really interesting because I know that some probiotics can actually increase histamines, right, which is like the opposite of what you're trying to do. And that initial, the strain that we start with helps to clear histamine. That helps decrease our histamin levels. Yeah. that's so helpful. I remember you also introduced me to systemic or proteolytic enzymes for kiddos. You take this on an empty stomach and I was like, how are we going to do that? I remember we figured out a way to put them on cucumbers with a little bit of salt so that they can just be eaten without a protein-containing meal.

That can be a really big game changer too for cleaning up some of the gut microbiome. Yes, so the way that I like to think about the systemic enzymes, we have over 3,000 or thousands of enzymes in our body, and about 25 or 30 of them are for digestion. When we are using the systemic enzymes that we use, they're going to get absorbed and they are going help with detoxification, with nutrient exchange, oxygen exchange and it's a really big support for the immune system. Most of us in the office take them and I actually take it every day because I have Hashimoto's and take a protease.

in the morning because you have to take your thyroid medication on an empty stomach. So I have a protease capsule in each of, you know, I set it out for the week so that I'm taking that along with it. But it not only helps with the system, but it also helps Oh my gosh, how did I? Oh, it helps open up biofilms. So it's right when we've got some not so beneficial bacteria in the gut, It creates biofilm around itself. And when were doing those proteases on an empty stomach, those are going to help to open those bio films.

It serves several purposes and it is really working with our body's natural function. It's really interesting because they have helped so many people with pain and reducing thyroid antibodies, the proteolytic enzymes and a little bit of protease and eczema. There's a big root cause of these different infections. I think a lot of times you know, when I've been trained in pharmacy school, it's like if you have an infection, you take this antibiotic or this treatment for it. But the tricky part is sometimes the infections can live in the biofilms, which is basically like a mucus-based home where they keep themselves protected because we do know that You mentioned some of the different bacteria like staph can contribute to eczema.

There's also protozoal infections and potentially fungal and mold colonizations that can be contributing. Is that right? It can get pretty challenging if you're trying to say, OK, we're going to treat this one thing and this 1 thing in this thing. Instead, what we do is we say we are going support the overall system and the function so that our own immune system can take over and address what needs

At-home eczema support and lifestyle changes 47:30

to be addressed. I mean, of course we use antibiotics or antifungals or things if we need them, but often we were able to make the shift without having to go in and use some of those other treatments to quote unquote kill things. Along the same lines, I think it's helpful. I remember being in residency 20 plus years ago now. The infectious disease doctor said, as he was describing antibiotics, so the antibiotics just bring the bacterial count wherever it is, whether it be ears, lungs, potentially the gut or the skin, they bring that bacterial countdown to an amount to where our own immune system can then take over and address the rest of it.

So we can't, it's always the yes and, we have to use all of the pieces of puzzle so that we're working with our immune systems, not against it Yeah, it's so important to consider all the tools in a toolbox. I know sometimes I, in my circle of colleagues and friends and clients, there's some people that are very much like, you know, some of my friends from pharmacy school that were like this is voodoo, I'm not going to touch it. Then some my more natural minded friends that Zero drugs, every drug is bad for you.

And it's like, you know, when you've got a chronic illness or a health care condition, let's utilize every tool that we can in our toolbox to have some healing, right? And if you use medications correctly, then you're not gonna have problems. Yes, amen. I am the first to say if we need a chest x-ray and an antibiotic or, whatever, I wouldn't be around if there weren't I have been I've had all the things and I without conventional medicine I would not still be here and not that sounds dramatic but right it's I mean I Even in terms of Kenny, I've been hit by a car.

I'd been thrown off of a horse. When I was younger,I used to get kidney infections and Hashimoto's now. But when you support your system and you understand, what I always say is if we understand about chemistry, physiology, the way our nervous system is put together. For a parent, that just means pay attention to the signs. All of these you know, the symptoms that we have are something to pay attention to. And my book helps to illustrate that. I would consider you one of the world's leading functional medicine pediatricians.

How do you think your own journey has shaped how you practice medicine? And, you, know what about your journey got you into medicine. That's overly kind. Thank you. I appreciate that. I wanna, I'm gonna say two quick stories is the first one was just about eczema and it was, and because I've always listened to parents, every day's a school day, there was a pediatric surgeon when I was in residency who would always say that and I adopted his motto is there's always something to learn. And so when the mothers would tell me that they would do something and at work, they always researched it, read about it.

paid a lot of attention to it. One mom, we'd been working with this kiddo for a while, and his eczema would get better, but it would keep flaring. He was getting recurrent MRSA boils, so those methicillin-resistant staph aureus boils. She ultimately found the Dr. Aaron topical and had started reading a dermatologist out of Chicago. I think it probably was Peter Leo. It didn't realize it at the time. But she said, you've got to get a hold of this Dr Aaron. She got his email address for me and I emailed him and we started corresponding.

So I prescribed the topicle even though I wasn't 100 percent sure. I needed to understand more how to do it, but Dr. Aaron was helping me and guiding me. Finally, we got on the other side of this kid's eczema. That was one of my journeys, and that was coming into functional medicine. I realized what a profound impact we could have on these more chronic childhood issues when we use the best of conventional and integrative medicine and meaning nutrition supplements mind body therapies. And then when it comes just for me, I did during medical school, right before medical, school actually I was at Ohio State and I got diagnosed with Hashima with, with a hypothyroidism and it was the student medical center.

And I can remember it because right thyroid disease is is fairly common, but I remember the clinician at the Student Health Center opened up her book and I almost felt like she was reading. This is my recollection of it, what actually happened. I don't know if that's exactly how it happened, But she said, of all the things to get, this is the best one because all you have to do is take a pill for the rest of your life and you'll be fine. And I took it at face value and I was like, oh, lucky me. And, you know, just started taking the medication.

But I, I had never been a napper. I would go home falling asleep. Then eventually, and it wasn't for probably 12, 15 years after that, that I started to realize, oh my gosh, I should have gone off gluten and dairy the minute I knew about this. Could I have shifted things and could I had prevented myself from being on medication still? I don't know, and I've tried doing that, but I have not been able to get off the medication. But I consider myself to not have any. It's not something I think about very often because I feel great.

I'm super physically active. And I have to, you know, I'm off of dairy and gluten and I do take many supplements and, You know I, have this sweat several times a week in order to help my body detoxify, but it's, once you, know those tools, it is an absolute game changer, which you now intimately. Yeah, absolutely. And I think for me, it's always a challenge of I know that Hashimoto's can be reversed to the point where we don't have the symptoms and we can live a full and wonderful and energized an active life with plenty of brain function and maintaining a healthy weight and all of that, sometimes if your thyroid gland is destroyed and has been under attack for a while, then you're going to need to take some thyroid hormone, right?

And oftentimes, you do need take that. But I do know for most people, it's not the be all end all. It's like you need have thyroid hormones and these lifestyle changes to feel your best. But it's always fascinating for me when other conditions can be reversed, where you don't have symptoms of asthma or eczema. It's sort of like an ongoing journey for my being a pharmacist where I'm like, oh yeah, you can absolutely reverse Hashimoto's. And then when my son had exima, there was this doubt in my head because I knew so many people that had Eczima.

kids with eczema and they struggled with Eczima and then became asthma later. And so it's been wonderful to be able to connect with you and be like, oh, wow, this can be reversed too. Like, I almost don't believe it, but now I see, like I've seen it with my own eyes, right? And a lot of the things you recommend for exema are some of things I would recommend Hashimoto's anyway. Yes. That's the thing is because it is so foundational. It's worth looking we're building the strong foundation is it helps whether it's eczema, asthma, Hashimoto's, attention challenges, constipation, other gut issues.

Some of the talks that we do, we call it pediatric immune resilience. It's a universal approach to some of common childhood illnesses. But again, We say childhood because I'm a pediatrician, but it works. It's the same concept with adults. I have had with guinea pigs, I've had clients with Hashimoto's now that have a lot of skin issues. Then I'll take what I learned from you and I will be like, hey, have you looked into this? We'll do our Hashimoto's work with them. But then I also let them know about your work and they've bought your books.

They're not kids, right? It still works for them really, really well.

Gut health, probiotics, and digestive support 57:30

One tool that you and I have both used extensively, and i'm not sure if you're still using it, but it's the GI map test. Now, I was interpreting it differently. And then I learned how you interpret it. It was a bit different than I did. So there were certain markers. I remember you had mentioned, for example, if H. pylori, even if you saw a little bit of it, you would consider that a positive test, whereas I would only consider it a negative test if it was like in the red. There's been really, really interesting to see some of the differences.

Is that one of your tools in your toolbox these days? It is, and it is interesting because it's continuously evolving how we're using these tests. As you know, we've got hundreds and hundreds of species of bacteria in the gut. Our research and our understanding of how to utilize this in clinical practice is evolving as we speak. Even now, Well, HPYLOR is such a good example because it can be, you know, kids can have it in their gut and it's controversial whether it should be treated or not. And we actually, even though we absolutely always pay attention to it, we're not necessarily going in and treating.

We're usually supporting it with supplements, but we rarely, rarely go in and treat with the quadruple antibiotic therapy that are used in conventional medicine. But that has been the study that we have used for years, and it continues to hold us in good, that, we like using that because we've just seen good results with it. Yeah. I appreciate your approach because sometimes being a pharmacist, I tend to jump to like the big guns. Like if you've got an infection, let's bring out like everything.

But with kids, that can be really, really overwhelming as well as with a lot of sensitive adults. So I know you, you can use very gentle things like zinc carnosine, for example, to help like an H. pylori infection and bring that to normal, right? Absolutely. And it's we can use those when we support with those natural therapies and we make sure that we have good motility, that motillity and then the bile from the gallbladder that is going to do a whole lot in more than anything, any pill or prescription or supplement we could use.

to keep the small intestine balance and the colon for that matter. I mean, the bile from the gallbladder literally goes into that small intestin and it pokes holes into the not so beneficial bacteria. And when you keep that the bad bacteria at bay, that allows the good bacteria to flourish. We want that small intestine to be fairly clear. Most what we're talking about of the microbiome and all these bacteria are in the colon. But it's the health of this stomach, good, strong stomach acid. Then a lot of food is absorbed in this small intestines and then the whole in is for excretion.

but the health of each of them plays a big role in the whole, and when we have that good function of the pancreatic enzymes, of bile, the motility, that's really going to be a huge role of keeping everything balanced. I love that. And I know you also had recommend some very gentle digestive enzymes too. I think those are mentioned in your eczema guide too? Yes, absolutely. In that, it's function, function function and digestion absorption. When you think about with kids, right, if we're talking about the really healthy cell walls and adults, fats make up our cell wall.

And if you've ever had kind of compromised digestion, and then you eat a fatty meal, you just get more indigestion. So for taking most of the kids who come to see us are at a place of depletion. and inflammation. If we start just throwing and saying, okay, let's do some fish oil and some of these other things, we're going to just create expensive stool and urine. What we do is we get the gut ready and it always involves using digestive enzymes because we want to fully break down those fats and absorb them.

The fats make up our cell walls and they make our hormones. Then we want to look at the proteins. Proteins make up our neurotransmitters and they make our enzymes. It's really important to have the natural resources we need to produce what our body needs to function. I love that. And it's gentle and it could be very, very effective. It's been really interesting for me just to see some of the patterns in people with Hashimoto's. I know a lot of times I'll see people that have hives and Hashimoto's and IBS, they might have something like the protozoa blastocystis hominis and you can see that on a GI map test.

Are you seeing any kind of like weird patterns with the kids that you're seeing with asthma or eczema of things that maybe aren't really out there in the research, but you are seeing clinically? We will see. The kids who have a lot of inflammation and this has been going on for a while and they've been on a lots of antibiotics and maybe steroids. There's a dysbiotic section on the GI map and that will light up like a Christmas tree. So many of the not so beneficial bacteria will be very high. Then we might see some of the autoimmune trigger bacteria elevated.

Then when you go plus or minus the yeast markers, even though we suspect they've got some imbalances in that realm, we don't always see it show up. But then you and there may be a parasite and Some inflammation, we may see some fat, the steatocrid, that is actually getting spilled into the stool and we don't want that. We want the fat broken down and absorbed. You might see a little bit of blood, which means inflammation. we might see the calprotectin a little bit elevated. Calprotctin is a sign of colon inflammation.

We definitely don't want to see that. That is something that we will see if kids have really severe constipation or if they have inflammatory bowel disease. the gliadin antibody. That's an antibody against the gluten molecule. We always do blood work to see if we see any of the celiac antibodies elevated in the blood. If those are negative, but we're seeing the gliodin positive in this stool, we will proceed typically with pulling them off of gluten at some point in time. So it's there, we absolutely, and we use it as a guide.

We're not, again, not going in and necessarily killing things, but we're using it a as guide to give us an indication of what the overall, what's going on in the gut, in an overall standpoint. It's fascinating. I know somebody recently was like, why aren't you sponsoring research studies on what's going on in the gut and Hashimoto's? And I'm like well, I wrote a blog about it, but it's amazing. There's so much happening in functional medicine and sometimes people might hear, they're going to the research or they might here like oh, this doesn't work.

there's no connection between the Gut and eczema, But you've done hundreds, maybe thousands of these tests and you see these patterns. And I feel like it's important for parents to advocate for their kids and adults to educate for themselves. Right. When you've got some skin issues, autoimmune issues going on and to really appreciate that you might need a deeper look. Oh, yes. Yes. And we have interesting one of the dads in our practice who's a statistician whose childhood eczema they'd been to many different doctors and he you know, has had a wonderful transformation, he was, is helping us kind of look to see if we can look at clinical outcomes because that's the, that the thing is we're changing in a, in conventional medical research model, you're going to change one variable and look at the outcome.

And what we're doing is we are saying, look, there is not a single variable, we've got to look nutrition, the environment, and the function. and we're going to change these different variables, but we are going change them with a consistency in getting the function. Our foundation is the same every single time.

Clinical testing, research, and practitioner resources 1:07:30

I'm sure you remember as we go back and say, I know that you've done these other probiotics, that we have to start with this one because we've got to prime the system to get it ready for the next steps. I would love to have big outcome studies, but people also have to realize that the pharmaceutical industries are usually the ones who are funding a lot of the studies because they have the money to do it. The lettuce industry is not funding studies to show how green leafy vegetables enhance the microbiome.

Absolutely. I know when I was in pharmacy school, which was many moons ago, it was like a billion dollars to bring one drug to the market. And I'm sure it's even more money now to do all of the applications of research and so on and forth. But I really appreciate you spreading the word that eczema and asthma and allergies are reversible, that they are not somebody's destiny just because it is in their genetics. Could you tell us a little bit more where people can learn about your work? I know you have a book that anybody can get and help their children with.

You have practice, and then you also do mentorship for clinicians. Yes. I have my book, it's Healthy Kids, Happy Moms, Seven Steps to Heal and Prevent Common Childhood Illnesses. you can it on Amazon or anywhere books are sold. very detailed. The first 10 chapters is the science, the second section is how to, and the third are recipes. Then we have an online course. We do take on a limited number of new patients each month in our practice. Mentorship, you can reach out to our office if you are interested in that.

We do different cohorts of that. If you want to be put on the wait list, you can just send an email to support at SheilaKilbane.com. We've got our supplement store and we've tried to put things together and move a blog. When we put these together so that it's as easy, we can start to figure out how to DIY at home. if you don't have access to a practitioner. But you can always reach out to our office if your able to travel to North Carolina for a more institutionalized approach. I so appreciate all the work that you're doing and I also really appreciate you creating a free guide for people, the eczema quick start guide that people can get.

We're going to link to that and that way they can start, get their kids started or themselves started on an exima healing journey. I know personally going through the process, it was a game changer for my son and I feel like even with some of the people will say you mentioned focus issues and he was in preschool and wasn't really interested in writing or whatnot and then all of a sudden he's writing his name and doing a lot more preschooler work that I think was bothering him so much that he wasn' able to focus.

It was really, really interesting. It's that gut-brain connection. You just can see it more clearly with kids because we're always observing them. He did well, and you did a lot of work. Yes, I didn't sleep for a few years. My brain is still recovering. But thanks to you, you know, we got him sleep, and we get him less itchy. And we, like I said, his skin has completely transformed. He does not have eczema and really I just want to shout it from the rooftops. If anybody has a child with eczema, please, check out Dr.

Sheila Kilbane. She's got her books, blog posts. You can go see her in person because you're really changing the world. and you're really helping families. You are super, super kind. I appreciate your sentiment and I just want everyone listening to know that there is definitely, there are so many things that you can do. So keep, just start one step at a time. Yeah, I love that. And thank you so much for offering so hope for parents everywhere. Now it's time to do some of the rapid fire questions.

One of them would be for you, is there a wellness hack that you've personally refused to participate in? Oh, interesting. I'll say the wellness hack that I love is cold plunging. But the thing that i refuse to is, I eat the food that works for my system and I think that we've gotten into this thing of you should be grain-free, that were sort of using and eliminating certain food groups and we wear a badge of honor or that it's this big thing. I would be eating all the things if I felt good on it, I think we should have as expanded of diet as we can and feel good with being healthy.

I guess that would be the one thing that I would say that I'm not going to continue to take everything in. I do do some sugar, but try to limit it. But I try not to live in a complete bubble. Yeah, I agree with you. I feel like elimination diets have a time and place and definitely I know in the Hashimoto's community, there was a trend for like the autoimmune paleo diet. And I think that can work really well. But I've also seen people on this diet for, like, seven to eight years that I worked with.

where they come to me and they're so depleted and have so few foods that they can eat and are super symptomatic and a lot of times we're like, but there's these other things that are going on in your gut and if we actually address these things like one, you're going to feel better and two, your thyroid antibodies are gonna go down and it's just like I think when you over focus on on that, and I think that can be more of a wellness trend that could become a bit toxic. For me, like I said, it really broke my heart when I started seeing this extreme elimination diet for eczema in kids.

I was like, I can't do this. You know, hormonal, sleep-deprived, then want to help my baby, but I'm like this can not be it, right? Yes. Yes, definitely. And I will say, I think you're the first person with Hashimoto's that likes cold plunges that's been on the podcast. I left so hard that you had a post of you were like in all, you have your down jacket when everybody else was in their t-shirts and all of the things. And that is exactly how I am. Like I always have many more clothes on than everyone else around me.

But for whatever reason, that cold plunge is I think, of course, it's the dopamine that I love. And I don't do it every single day. If I feel anything, if I fell off, I haven't slept well, then I won't. But it just feels so good to me. I hate it going in, but I like it when I get out. And I think it's important consideration too, because, you know, your Hashimoto's journey and triggers might be different than another person's Hashimoto's Journey and Triggers, and you might further along on your journey than somebody else.

And so that's something that is working really well for you right now. I struggle with people being like all or nothing with things where they're like, if you have this, you should never do this. Where I'm like there's so many nuances here, but perhaps for most people, this isn't a great idea to start with, right? For sure. Do you any guilty pleasures that aren't doctor approved? Of course. I mean, who doesn't? The one, I love Prosecco, right? It's just, it's like, a carbonated, Italian, kind of like a carbinated white wine.

But if we're, you know, having dinner or something like that, that is my, always get an organic one. I just love to have a glass of Proseacco. And I guess, what do you wish more people would know when it comes to children's health? Common sense is we are, and I mean that in a good way, is that we're being marketed to parents. Everything that your child sees is to get so that companies, the food industry, can sell more food. whether it's fast food, whether its sugar cereals, right? Millions and millions of dollars are spent on how to get people to buy these things.

And we're, because when we, we get a lot of, a fair amount of grief in the integrative and functional medicine space for trying to gets kids to eat healthy and depriving them. I don't think that by not giving your child things that are not actually real food is depriving them. So we just have to think about what are we putting in our bodies and how can we really look at food with our kids without feeling too guilty as a parent and with, again, not living in that bubble. But there's a big difference between a bag of colored candies regularly and just having it every once in a while.

Yeah, thank you so much for sharing that. I think it can be a really, you know, for me, I've lived in Boulder, Colorado for a while, and it was like a real big culture shock. Actually, now live in Austin, Texas, where there's like processed food everywhere. And I'm like, oh, my goodness, this is like really common part of the standard American diet. Yes. It's I, think, it's in schools. Again, it's little by little building up your arsenal of things that you're going to have or foods that can take with you.

Then maybe the friends that your kids have will start to do some of these things with, making it fun. Yeah, we try to make it fun. And unfortunately, my son goes to a school where they have an awesome lunch program. So they like organic food and wild caught grass fed all the things. He's very aware of his body. We let him have candy, but then we talk about, how do you feel the next day? And he's like, well, and sometimes when I have too much of this stuff then I can't sleep or and we're very good about you know talking about like and what happens when we skip meals and he's like yeah I feel kind of angry so I think just giving your children empowering them without of that awareness without being so restrictive but letting them have a little bit of their own understanding or natural consequences and tuning into their For sure, because to have that insight, I think many adults, we don't have the insight with how food impacts us.

And to start to help them to see that early on, when I took gluten out of my diet, it was like somebody took a bag off my head. I didn't had brain fog, energy slumps after I ate, my stomach felt better. my integrative training before I figured this out. If I couldn't feel that, how is a kid and how somebody who has no idea how food is going to impact them? I love that you're helping him to see that now. It's been quite a journey and thank you so much for being a part of our healing journey, helping us in such a challenging time.

We appreciate you and hold you in our heart forever. And thank for such being such light for so many families around the world and everybody listening, I hope this has been healing on your own journey.