How Diet and Lifestyle Can Support Those with Eczema
For as long as I can remember, I have been interested in all things wellness and health. I have been known to try all the newest products, and I have dabbled in many different health trends. My focus was always about eating and living in a way that would optimize my health, so that I would feel and perform at my absolute best. When I had kids, my scope of interest widened, and I became even more interested in what I put in, and on, their bodies. I have been good at reading my body and connecting the dots between what I eat and how I feel. I have always known that what we eat can heal us, but I really came to understand the true power of nutrition when my son Henry was born in 2013. From day one, Henry had eczema head to toe. Henry was my second child, but he was my first with a condition that I had no control over. I ate really healthy during my pregnancy and even healthier when I was nursing. Despite my best efforts, the eczema got worse and worse. I saw countless doctors, all of whom told me that what I ate as a nursing mom would not have an impact on Henry’s skin and comfort. They believed his eczema was something that could only be managed through topical steroids, and if anything, I could take a look at the detergents and creams we were using as they could be irritating him. Despite their advice, I could not understand how he could be so inflamed on the outside, but not on the inside. In addition, I knew that relying on steroids was not the solution. The inflammation on his skin was merely a symptom of a much bigger problem- and the steroid was a solution only for the symptom. During this time, Henry was diagnosed with a severe allergy to peanut and was in the beginning stages of asthma. I read everything I could about the correlation between asthma, allergy and eczema and I did not find enough about diet’s role. I found this hard to believe. Despite this, I put Henry on a strict elimination diet, and his eczema completely disappeared. Not only did the raw and itchy stuff go away, but his skin was supple again, not scaly and dry. As we continued on our eczema, asthma and peanut allergy journey with Henry, we saw more and more doctors. While they agreed the results of the elimination diet were promising, they were not in agreement that there was a correlation between certain foods (in his case, dairy and soy). In addition, they did not think that permanently eliminating foods was a solution. They wanted to make sure Henry could be a kid and eat the foods his friends were eating and that he wanted to eat, but also that we did not want to run the risk of Henry’s body building up a bigger intolerance to these foods that could present potentially in a more severe way. Henry’s father and I agreed to not completely eliminate these foods forever, but we also knew that we needed to keep these foods out of Henry’s system until his body could properly heal. It was a long process that required a lot of patience from both us, and Henry. Fortunately, as Henry has grown up, he has become more tolerant of the foods that irritated him, he has grown out of his peanut allergy, and his eczema has gone away. He also never got full blown asthma. Not all people are so lucky. I wrote a paper for one of my assignments in my holistic nutrition program to get a broader understanding of how I could help others. Fortunately, in the years since we were going through eczema with Henry, significant research has been done offering recommedationsfor both dietary and lifestyle intervention. Excerpts are included below:
What is Eczema?
Eczema is a common inflammatory skin disorder causing red and itchy skin. The onset of eczema most often occurs before age five, but it can affect people of any age. While it is a long- term condition, the skin is not always red and itchy. Instead, eczema tends to cause flare ups that may occur frequently, or years can pass in between them. Eczema is chronic and relapsing, meaning it can happen throughout one’s life.
Eczema not only affects a person physically. While it is true that pain and discomfort are a reality, the emotional toll eczema takes cannot be overstated. In fact, according to one study, 30% of patients with eczema have been diagnosed with anxiety or depression. As I will discuss later, anxiety and stress are not only a trigger for eczema but also can result from an eczema flare up. It is a problematic cycle. Up to 50% of patients with eczema and their families say that this disease has a severely negative impact on their lives. Specifically noted is sleep deprivation from itching, depression, and not being able to participate in certain activities (Tollefson, 2014).
Often, the root cause of eczema is not identified, rather a treatment of topical steroids or cortisone creams are prescribed. While effective at shrinking the flare up, and thus helping prevent eczema related infections, if the root cause is not identified, future flare ups are almost always inevitable. Fortunately, research has shown that through diet and lifestyle intervention, progress can be made in both preventing the onset of symptoms and keeping eczema at bay.
COMMON SIGNS OF ECZEMA
· Dry, itchy skin
· Thick and cracked skin
· Swollen skin resulting from itching and scratching
· Infected or oozing skin
POTENTIAL CONTRIBUTING FACTORS OF ECZEMA
Contributing factors of eczema are unique to the individual. Identifying them can often help better manage eczema, because understanding a cause, could bring a (better) solution. Abnormalities in the skin, an immune system disturbance or overactive immune system, genetics, a food allergy or intolerance, and gastrointestinal problems have all been pointed to as potential contributing factors of eczema.
Abnormalities in the Skin Barrier: Our skin is an important organ. It protects our insides from the outside. The top layer of our skin is our skin barrier, and normal skin barriers are thick, and shed dead skin cells and produce new ones without notice. In people with eczema, this layer is not thick, it is instead too thin. The result is that it does not function normally and can be easily irritated and dry. The result of dry skin is itchy and eventually painful rashes or flares (Fischer, 2016). These skin abnormalities also make it unable to protect the body from irritants, allergens, and bacteria, while also making it unable to retain moisture. Without this protection, the body is more susceptible to environmental allergens or an unfavorable reaction to topical products.
Immune System Disturbance/overactive immune system: Those with eczema may also release more histamine than those without eczema, which can result in the skin’s inflammation and itching. Essentially, they may have an overactive immune system and when triggered by something inside or outside the body, the immune system goes into overdrive causing widespread inflammation, which causes rashes and itching (Jones, 2020).
Food Allergy or Intolerance: Eczema is considered to be, in part, an allergic disease. This is because 80% of those with eczema have elevated IgE levels. IgE is an antibody that when elevated suggests an allergy is present. In addition, 100% of eczema patients have positive allergy tests. Food allergies are considered a “co-morbidity” of eczema. In fact, up to 30% of patients with eczema have a diagnosed food allergy. Dr. Peter Lio, a professor of pediatrics and dermatology at University of Chicago, says a food allergy triggers an immune response that can be eczema or any other inflammatory disease. If identified and the offending food removed, great strides can be made in keeping eczema at bay (Jones, 2020). A food intolerance can also be problematic. According to Karen Fischer, in her book “The Eczema Diet,” more than 40% of children who have lactose intolerance experience increased eczema symptoms shortly after consuming lactose. This suggests that the resulting eczema is related to consuming a dietary substance their body is known to be intolerant of; and supports the relationship between diet and eczema.
Genetics: There is a genetic component to eczema as well. A family history of eczema or of associated allergic diseases increases the susceptibility of the development of eczema. In fact, 2/3 of those with eczema have family history of allergy, and as many as 50% go on to develop an associated condition: asthma or hay fever (Murray 2012).
Gastrointestinal Problems: Poor gastrointestinal health is a main contributor of eczema. There is a strong and interesting link between the immune system and the gut, where 2/3 of the immune system lives. A disturbance in the gastrointestinal system can directly affect the immune system. There are a few gastrointestinal problems that are common in eczema patients including gut dysbiosis, and leaky gut (intestinal permeability).
Gut dysbiosis, or an overgrowth of harmful bugs or yeast in our gut, causes an inflammatory response in the body which can trigger eczema. In addition, if yeast is overgrown, eczema can result. An overgrowth of yeast is often caused by a diet high in sugar or refined carbohydrates, or heavy antibiotic or birth control use- so these should be avoided for good gut health (Hyman 2020).
Leaky gut essentially means that a once healthy gut is no longer healthy. The skin barrier is no longer strong enough to protect the body from allergens, bacteria, and other toxins (Fischer, 2016). In leaky gut, there is an inflammatory response to food particles that then leak through the wall of the gut and can cause a sensitivity to food – especially dairy and gluten, known main food causes of eczema (Hyman, 2020). Having leaky gut can also cause skin issues including eczema and overall inflammation in the body.
It is important to note what is NOT on this list, but that can make eczema worse: creams, lotions, detergents and other personal care and household products. While these products CAN exacerbate eczema, they are often not the cause. Instead, when the body is not in balance, they may have a stronger reaction to these products than if it were in balance (Hyman, 2020).
Nutrional Support for Eczema:
General approach:
Nutrition not only plays a significant role in overall health, but also in skin health and those suffering from eczema. What we do eat is as important as what we do not eat. By filling our bodies with anti-inflammatory foods, rather than those that inflame us, we will see great improvements in our overall health and in inflammatory skin conditions. In addition, removing processed foods and relying on a whole foods diet is imperative. Eating an anti-inflammatory diet, free of processed and inflammatory foods, can go a long way in making the skin get better (Jones, 2020). Dr. Mark Hyman agrees, saying good food is good medicine, but bad food will make us sick (Hyman, 2020). The goal is to treat the whole person with good food, rather than treating a specific disease. The result? Reduced inflammation, improvement of gut issues, a break for the immune system, and resolution of eczema (Hyman, 2020). Dr. Hyman argues that by putting bad food into our bodies, our whole body becomes inflamed and inflammatory skin conditions like eczema result. Even if eczema is genetic, eating a whole foods anti-inflammatory diet will cause a resolution of eczema simply by changing the diet.
Foods to avoid:
Less Acid Producing Foods are incredibly important to incorporate. Unfortunately, an acid producing diet, like the Standard American Diet, is not only making our bodies sick, but our skin as well. Studies have shown that for people with eczema, having an acidic diet can actually worsen their symptoms, whereas providing the body with alkalizing ingredients can greatly reduce flares and eczema discomfort (Hyman, 2020).
Chemical sensitivities: When we come into contact with a chemical; worsening eczema symptoms, along with other irritation, can occur. It is important to be aware of both natural and artificial chemicals, as both have been shown to cause these reactions. These include but are not limited to: Salicylates and nitrates in food, food coloring, sulfites, and MSG. It is recommended to not only avoid those foods, but also to eat organic as often as possible, and always wash all fruits and vegetables to remove any chemical residue. Reducing chemical load is very important. Studies have shown a link between food additives like flavor enhancers, artificial flavors and colors, preservatives, and artificial sweeteners found in processed foods, and the occurrence of eczema. The accumulation of all these toxins in our body is known as chemical load. In fact, large population studies show that in cultures without processed foods, eczema is rare (Fischer, 2016).
As noted previously, food allergies and intolerances are a major underlying cause of many of those suffering from eczema. For those patients, offending foods will need to be removed. In addition, it is important to reduce blood histamine levels. In people with eczema, an allergic response, and thus the release of histamine into the blood, can exacerbate eczema symptoms. If there is a stronger histamine response of course, like a severe allergic reaction, it is important to seek medical attention and not try to manage on their own. To find which foods cause this response, an IgE test can be taken, and foods identified as problem foods should be removed. The most common foods associated with eczema are eggs, peanuts, dairy products, and tree nuts (Fischer, 2016). An anti-inflammatory, nutrient rich diet, with healthy fats and protein sources that support the liver, blood and gastrointestinal health of the body is at the core of an eczema reducing or elimination diet. Histamine reducing foods high in vitamin C like papaya and Brussels sprouts are also recommended.
Recommended Foods:
It is important to note the below food recommendations are alkalizing, help decrease inflammation, and are beneficial in overall skin health and repair.
Healthy Fats
Flax Seeds are rich in Omega-3 fatty acids and are anti-inflammatory. They are also a great source of silica, protein, vitamin E and fiber – important for gastrointestinal health along with liver detoxification. Flax seed oil is also recommended.
Olive Oil is an alkalizing fat that is a healthy choice for those with eczema. It is also anti-inflammatory and antibacterial.
Avocado is anti-inflammatory, a good source of mono-unsaturated fat, is high in potassium and rich in fiber
Organic Fruits and non-starchy Vegetables
While it is encouraged to eat a diet rich in antioxidant and phytonutrient rich fruits and vegetables, not all fruits and vegetables are recommended for those with eczema. Those with naturally occurring MSP or salicylate may be problematic for eczema sufferers. Some wonderful options to include:
Bananas are wonderful because unlike many fruits that are acid forming, bananas are alkalizing due to their high potassium content. They are also a great source of vitamin C which is considered an “antihistamine vitamin” which is important in helping manage the symptoms of allergies. Bananas are also rich in calming magnesium (Fischer, 2016)
Papaya is one of the healthiest foods for people with eczema. This is because they are rich in carotenoids which help protect against inflammation. In addition, papaya contains lycopene which is protective of the skin against sun damage. They are also rich in vitamin C and papain- an important digestive enzyme. For eczema sufferers who are on an antibiotic due to an infection, eating a serving of papaya per day is a powerful way to rebalance gut bacteria.
Potatoes, while starchy, are a great source of vitamin C, potassium, and fiber. It is one of the only starchy carbohydrates that is alkalizing. Sweet potatoes are another wonderful option and are anti-inflammatory and alkalizing as well.
Mung Bean Sprouts are incredibly alkalizing, and also contain potassium, vitamin C and magnesium. They are also high in protein, iron, and fiber, and are a true nutritional powerhouse.
Brussel Sprouts are also alkalizing and contain a high dose of vitamin C and potassium along with antioxidants important for liver detoxification.
Non-Gluten Grains:
*Incorporating gluten is fine if it is determined to be well tolerated
Buckwheat is a non-gluten grain that is gentle on the digestive system. It is also rich in antioxidants and quercetin, which has been show to lower blood histamine levels while also being anti-inflammatory. It is also a great source of dietary fiber which supports a healthy digestive tract and good gut health.
Oats are a great source of protein and fiber, along with vitamin E, potassium, zinc, and iron. Interestingly, they are also rich in the mineral silica, which is important for strengthening the skin’s connective tissues (Fischer, 2016). Oats are also important for a healthy gut and for detoxification. If gluten is an issue, make sure the oats are gluten free and are not cross-contaminated.
Quinoa is a wonderful non-gluten, high protein, grain to incorporate and is very versatile.
Organic Protein Sources
· Free range and organic animal protein, skin removed
· Unprocessed meat, free of nitrates, nitrites, and preservatives
· Eczema friendly options include turkey, legumes, lentils, lamb, mung bean sprouts, cold water fish, and chicken
· Only include eggs if they are determined they do not cause the patient any problems. Many eczema sufferers are allergic or responsive to eggs.
· Dairy products should not be relied on as a protein source until determined there is not an allergy or intolerance
· Peanut Butter and nut butters should also not be relied on until further testing is completed
Water
Drinking at least 8 glasses of filtered water daily can help keep the skin hydrated and prevent it from getting dried out due to lack of hydration.
Key Nutrients:
Recommended dosages are noted for my client, where appropriate
Vitamin D deficiency is common and has been linked to health problems including moderate to severe eczema. In fact, studies have shown that children with moderate to severe eczema have much lower levels of vitamin D, than those children who do not have eczema (Fischer 2012). People living in cooler climates and who do not get as much natural sunlight, a wonderful source of vitamin D, are more susceptible to having a vitamin D deficiency. Vitamin D can be received through direct sun exposure of 10 minutes per day, but a diet rich in vitamin D, and a supplement, is also recommended in patients with eczema (Fischer 2012). The recommended supplemental amount of vitamin D recommended for children age 7, is 1200-2400 IU per day.
Omega 3 Fatty Acids from fish oil supplementation have been shown in recent years to be incredibly beneficial for those with eczema. This is because essential fatty acids, omega 3 being one of them, are really important for healthy skin. A flaxseed oil supplement is another good option. In fact, a study was done over a 12 week- period. Subjects were given either ½ teaspoon of flaxseed oil, or ½ tsp of olive oil. Those subjects who took the flaxseed oil were shown to have 10% less water loss from the skin and the skin was more hydrated overall. In addition, there was less skin irritation and roughness (Fischer, 2016). It is recommended that Omega 3 fatty acids be in food form vs. supplement form if possible, because they are better absorbed by the body that way.
Vitamin E is very important for skin health. A study has even shown that in those that supplement Vitamin E, there was a decrease in the IgE levels of those with allergies and that when taken over an 8 month period, 50% of adults with eczema reported improvement and in some it completely went away. In no one, did their condition worsen. The recommended supplemental amount of vitamin E recommended for children age 7, is 60-90 IU per day (Fischer, 2016).
Vitamin C is an antioxidant imperative for skin health and repair. It also helps reduce moisture loss in the skin. Getting vitamin C through a variety of fruits and vegetables is ideal especially citrus fruits, dark leafy greens, Brussels sprouts, and strawberries (Kresser 2017).
Quercitin is an antioxidant in fruits and vegetables. It is a natural antihistamine and anti-inflammatory. Quercitin should be taken only in a multivitamin containing vitamin C, taken two or three times daily rather than in a single dose. The recommended total daily dosage for 7 year- old’s is 40-60mg.
Probiotics are very important for those suffering from eczema because they help ensure there is a balance of microflora in the gut. If there is an imbalance of microflora in the gut, there is an increased risk for food intolerance and skin issues. This is because with this imbalance, harmful pathogens can take up residence in the gut. Studies have shown that an imbalance in the gut’s microflora could be a precursor for eczema and the presence of bad bacteria in the gut has been associated with a higher risk of eczema and allergies by age 2. Probiotics play an important role because they not only help balance the gut’s microflora, but they can help protect and heal the gut as well (Fischer, 2016) In addition, many people who have eczema have had to take frequent antibiotics for infections resulting from scratching the eczema. Antibiotic use can cause an imbalance in microflora and as a result those with eczema may be at increased risk. Not all probiotics are the same. For those with eczema, the strain L. rhamnosus has shown to be the most effective. A probiotic supplement should be taken daily.
Carotenoids, specifically cryptoxanthin, has been shown to help keep the skin hydrated. Papaya is a wonderful example of a carotenoid rich food. Other options are carrots, beets, and sweet potato. It is beneficial to eat one serving (total) per day (Fischer, 2016)
Zinc is anti-inflammatory and an important player in the skin’s immune function and in helping heal wounds. It is recommended to get zinc through food sources like beef and lamb, or through vegetarian sources like pumpkin seeds and nuts. 10-15mg per day is recommended for 7 year-olds (Kresser, 2017).
Herbs:
Turmeric is a potent anti-inflammatory and antioxidant and is important to include a few times per week at a minimum. It does have a strong taste, and is easy to incorporate in teas, curries, or added to a smoothie. It is also antibacterial, and in some research has been shown when taken orally to reduce itching.
Lavender is recommended for stress management. Because it can be highly concentrated, it is best to not apply topically as it can cause burning and irritation. This includes in lavender scented creams or lotions. It can instead be rubbed on the side or bottom of the pillow before bed to help with restful and restorative sleep (Murray, 2012).
Holy Basil (Tulsi) is an adaptogen then helps the body adapt to stress, which is incredibly important for eczema sufferers. It is also a potent antioxidant and is anti-inflammatory. Holy basil is wonderful taken in tea form (Christianson, 2020).
Calendula in skin care products can be beneficial for eczema sufferers due to its anti-inflammatory, antiseptic, and antibacterial properties. Discontinue use if redness or irritation occurs after application.
LIFESTYLE SUPPORT
Stress Management: Any kind of stress can not only trigger eczema but can also make it hard to clear up. This is because stress increases inflammation both internally and externally. Talk therapy, exercise, yoga, and meditation can be really beneficial to help manage and reduce. There are also eczema support groups that many find helpful.
Limit Bathing: taking baths or showers, especially in hot water, can be incredibly drying for the skin. Limit baths to 2-3 days per week with lukewarm, and not hot water. This may seem counter -intuitive but bathing in water actually dries the skin rather than moistening it.
Good quality restorative sleep: This can be a challenge for patients with eczema, who tend to itch often while trying to sleep, which then wakes them up. Poor sleep is associated with greater stress, which can cause flare ups. In addition, poor sleep can increase inflammation in the body, making eczema even worse (Hyman, 2020). It may be helpful before bed to moisturize the skin, and sleep in a “wet wrap” or wet pajamas. This can help trap the moisture in and better absorb into the skin.
Develop a healthy skin care routine: Appropriate skin care is imperative to not only repair but also to maintain the skins barrier (Tollefson 2014). For patients with eczema, a healthy daily skincare routine is critical. Everybody is different, and therefore react differently to different skin creams. It is important for all patients to keep their routine simple, with only clean and fragrance- free ingredients. Pay special attention to all ingredients used- the cleaner the better.
If you have a flare up, avoid itching: itching an eczema flare up has a high likelihood of leading to infection. This is because bacteria and other toxins can seep into cracks of the skin and cause infections that could need medical intervention.
Avoid soaps and products that can dry out the skin: the goal is to keep skin from getting dry.
Protect the outer layer of skin and help to prevent dryness by using clean and non-irritating moisturizing creams. Avoid products containing sulfates, fragrance, isopropyl alcohol, DEA and MEA
REFERENCES - Thank you to these experts, who shed a new light on a condition that at one time made me feel so alone and helpless
Bauman, E. (2017). Foundations of Nutrition Textbook. Penngrove, CA: Bauman College
Brannon, Heather (2020). “Common Side Effects of Topical Steroid Use.” https://www.verywellhealth.com/steroids topical-steroid-side-effects-1068831. Accessed February 20, 2021
Businco, L. et al (1982). “Results of a Milk and/or Egg Free Diet in Children with Atopic Dermatitis.” https://pubmed.ncbi.nlm.nih.gov/7180794/. Accessed March 2, 2021.
Christianson, Sherry. “The Health Benefits of Holy Basil.” https://www.verywellhealth.com/holy-basil-4766587. Accessed March 14, 2021
Fiocchi, A. et al (2004). “Dietary Treatment of Childhood Atopic Eczema/Dermatitis Syndrome.” https://pubmed.ncbi.nlm.nih.gov/15245364/ Accessed March 5, 2021
Fischer, Karen (2016). The Eczema Diet. Robert Rose, Inc. Ontario, Canada.
Hannibal, Kara (2014). “Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation” https://pubmed.ncbi.nlm.nih.gov/25035267/. Accessed February 19, 2021
Hyman, Mark (2020). “Seven Strategies to Eliminate Eczema” https://drhyman.com/blog/2015/11/12/7-strategies-to-eliminate-eczema/. Accessed February 10, 2021.
Kresser, Chris. (2017). “A Functional Approach to Eczema”. https://kresserinstitute.com/functional-approach-eczema/. Accessed January 15, 2021.
Murray, Michael T. and Pizzorno, Joseph: The Encyclopedia of Natural Medicine, 2012. Atria Paperback, New York, NY.
Pacor, M.L et al (1990). “Eczema and Food Allergy in the Adult” https://pubmed.ncbi.nlm.nih.gov/2359866/. Accessed January 4, 2021.
Sloper, K.S et al (1991). “Children with Atopic Eczema: Clinical Response to Double Blind Food Challenge” https://pubmed.ncbi.nlm.nih.gov/1754670/. Accessed February 19, 2021.
Theoharides, T.C (2018). “Stress, Inflammation, and Natural Treatments.” https://pubmed.ncbi.nlm.nih.gov/30574737/ Accessed February 19, 2021.
Tollefson, Megha (2014). “Atopic Dermatitis: Skin Directed Management.” https://pediatrics.aappublications.org/content/134/6/e1735. Accessed February 19, 2021.
“Atopic Dermatitis” Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/atopic-dermatitis-eczema/symptoms-causes/syc-20353273. Accessed January 30, 2021.
“Eczema and Emotional Wellness.” The National Eczema Association. https://nationaleczema.org/eczema-emotional-wellness/#:~:text=Eczema%20and%20Emotional%20Wellness%201%20Take%20care%20of,other%20negative%20emotions.%203%20Diet%20and%20eczema. Accessed February 19, 2021.
“Eczema Food Allergy Triggers” (2020) Eczema Holistic Healing. https://eczemaholistichealing.com/eczema-food-allergy-triggers/. Accessed February 19, 2021.
“Everything you need to know about Eczema and Food Allergies.” National Eczema Association. https://nationaleczema.org/eczema-food-allergies/. Accessed February 19, 2021.
“Science Has Spoken: Stress Relief Techniques Help Eczema.” National Eczema Association. https://nationaleczema.org/stress-relief/. Accessed February 20, 2021.