How Food Intolerances and the Gut Influence Your Skin Health
Eczema has become increasingly common over the last few decades. Worldwide, up to 20% of children and 3% of adults are estimated to have eczema, with rates continuing to rise [X].
Specific causes of eczema are not fully understood or agreed upon. Like most chronic conditions, there are likely a number of factors involved in the development and severity of eczema.
Food intolerances or sensitivities and underlying gut issues may be among the factors contributing to the rise in eczema and other chronic, inflammatory skin conditions [X, X, X, X, X, X, X].
In this article, we’ll explore some of the foods that may lead to or trigger eczema, including gluten, high histamine foods, and dairy products. We’ll also look at emerging evidence that suggests eczema may be an autoimmune condition. Finally, we’ll discuss how dietary adjustments and other gut-oriented approaches may help you resolve eczema for good.
The most common type of eczema, atopic dermatitis, is a chronic condition characterized by skin inflammation and itchiness.
Symptoms of eczema may include:
- Persistent itchy skin
- Redness or rashes
- Sensitive, inflamed skin
- Small, raised bumps or hives
- Itchy blisters on the feet and hands (as in dyshidrotic eczema)
Conventional treatment for eczema is generally limited to creams and ointments as recommended by a dermatologist. In more severe cases, immunosuppressant drugs like Prednisone are sometimes recommended.
At best, these treatments may provide temporary relief of symptoms, and at worst, they may offer no help at all. Prednisone has serious, known side effects. In any event, these treatments require ongoing use and fail to address the underlying cause of skin inflammation.
Foods That Cause Eczema
A systematic review of 66 studies show a strong link between eczema, food sensitivities, and food allergies [X].
Certain foods have been shown to trigger both immediate reactions and eczema flares that occur up to two days after consumption [X].
If you have eczema, you may want to explore possible food triggers. A few common food sensitivities, like gluten, dairy, and histamine, have been linked to eczema.
Gluten, a protein found in grains including wheat, barley, and rye, has been shown to trigger skin reactions and conditions in some patients [X, X].
- Individuals with celiac disease are more likely to have eczema than those without [X]. This may lend support to an emerging autoimmunity theory of eczema, as celiac disease is also an autoimmune condition.
- Wheat allergies have been linked to eczema and found to trigger symptoms [X].
- One study found that more than 30% of eczema patients had antibodies that reacted with gliadin (a component of gluten), compared to 6.5% of healthy individuals.
- The researchers suggest that gluten may be a trigger for eczema even among those who don’t have celiac disease or a wheat allergy (i.e., non-celiac gluten sensitivity).
- A survey of patient-reported outcomes found that more than half of those who removed white flour and/or followed gluten-free diets showed improvements in eczema symptoms [X].
Histamine is a chemical compound your body releases as part of a healthy immune system response. It is also found in certain foods.
Research suggests that excess histamine contributes to eczema in some patients [X, X]. Histamine is also involved in asthma and allergic reactions, both of which are common alongside eczema [X, X, X].
- A small study of 36 patients saw a significant improvement of eczema symptoms in a third of patients after following a low histamine diet for just one week [X]. After the dietary trial, provocation with histamine aggravated eczema in a subgroup of patients.
- A study of 360 individuals found that markers of high histamine levels were significantly more common among those with eczema than among those without [X]. A low histamine diet was shown to reduce the severity of histamine intolerance symptoms, including eczema.
If you have already tried a standard anti-inflammatory or elimination diet without much improvement in eczema symptoms, a low histamine diet may be worth a try.
Foods to avoid on a low histamine diet include:
- Fermented foods including yogurt, kimchi, and sauerkraut
- Aged or cured meats and cheeses
- Certain fruits and vegetables including spinach, tomatoes, and citrus fruits
Other Eczema-Related Foods
Let’s discuss research behind other foods that may cause eczema.
- Milk and dairy products: A higher percentage of eczema patients have been shown to have antibodies to cow’s milk compared with healthy individuals [X].
- Eggs: Especially in pediatric cases, common allergens like milk and eggs have been shown to trigger eczema flare-ups [X].
- Nightshades: A survey found that 51.4% of patients who eliminated nightshades reported improvements in eczema symptoms [X]. Nightshades are a group of vegetables that include tomatoes, peppers, eggplants, and potatoes.
- Dyes and preservatives: In a study involving 50 adult eczema patients, more than half showed significant symptom improvement when avoiding common irritants including dyes and preservatives [X].
- Fast food: Diets high in fast food have been associated with an increased risk of developing eczema [X].
Is Eczema an Autoimmune Condition?
In autoimmune conditions, the immune system attacks your cells or tissues. Symptoms of autoimmunity vary significantly depending on the area of the body that is being attacked. For example, in the case of Hashimoto’s thyroiditis, the immune system attacks the thyroid.
In autoimmune skin conditions, the immune system attacks your skin cells [X]. Skin conditions that are classified as autoimmune diseases include psoriasis, dermatomyositis, and autoimmune vasculitis.
Emerging research suggests that atopic eczema might fall under this category too [X].
Why does this matter? If we can connect external symptoms like eczema and itchiness to root causes, we can identify true treatment rather than just suppressing symptoms.
Eczema and the Leaky Gut Theory of Autoimmunity
Leaky gut has been linked to the development of eczema [X]. Increased levels of the protein zonulin, often used as an indicator of leaky gut, have also been linked to the presence and severity of eczema [X].
- Leaky gut, which occurs when the intestinal lining becomes damaged and allows bacteria and food particles to leak into the bloodstream, may also connect to autoimmunity and food intolerances [X, X].
- When the immune system encounters misplaced food particles, it may respond to them as though they are threats.
- This hyperactivity can then contribute to the immune system attacking your own cells.
Studies have shown that healing the gut can help treat some autoimmune conditions, including Hashimoto’s thyroiditis and inflammatory bowel disease (IBD) [X, X, X]. This may be relevant for eczema treatment, given that some research now suggests that it is an autoimmune condition as well [X].
Identifying the particular foods that trigger your inflammatory reactions can help to resolve eczema. This can often be done by following an elimination diet.
In addition to dietary changes, working to heal underlying gut issues may be necessary.
Elimination Diets for Eczema
There are large gaps in research when it comes to the use of standard elimination diets for eczema.
An analysis of 43 research papers found mixed results regarding elimination diets specifically focused on eggs and cow’s milk for eczema [X]. Most of these studies only involved children, so the relevance for adults with eczema is not entirely clear. No high-quality studies looking at more general elimination diets or more restrictive versions were available.
If we get more specific, some studies have shown that eliminating gluten or high histamine foods can improve eczema symptoms in certain groups of people [X, X, X].
Future research may help elucidate the role that diet plays in eczema more generally and the efficacy of standard elimination diets.
But, as with most chronic conditions, there is no specific “eczema diet” that will work for everyone. An elimination diet is inherently experimental and is meant to be tailored to each individual’s needs and reactions.
With that in mind, here are a few guidelines for following an elimination diet for eczema:
- A good place to start is to follow an anti-inflammatory diet, such as the Paleo diet, for 2-3 weeks. The Paleo diet eliminates many common eczema triggers and inflammatory foods. It focuses on fresh, whole foods.
- If your symptoms improve after 2-3 weeks, you may start to gradually re-introduce some of the foods you have eliminated. This can help you to identify specific foods that trigger your symptoms, including gluten or dairy products. During the re-introduction stage, it’s best to continue to avoid processed foods, fast food, and sugar, which are invariably inflammatory.
- If your symptoms do not improve, try another approach like a low histamine diet.
Can Probiotics Help?
Research on the effectiveness of probiotic supplements for eczema is mixed.
Dysbiosis (an imbalance between beneficial and harmful bacteria) in both the gut and skin microbiomes has been linked to skin conditions including eczema [X, X, X].
Treatments like probiotics that target the gut microbiome, therefore, may help in both the prevention and treatment of atopic dermatitis (eczema) and other skin conditions [X]. Additionally, some clinical trials have shown improvements in eczema symptoms with probiotics [X, X].
Probiotics both during pregnancy and during late infancy have also been shown to help reduce the risk of eczema for young children [X, X].
However, a meta-analysis of 39 studies concluded that probiotics were not significantly more effective than a placebo in treating eczema symptoms [X].
Other dietary supplements, including omega-3 fatty acids (known for their anti-inflammatory effects), may offer some benefit, although research is still limited [X].
A Gut-Focused Treatment Approach for Eczema
The relationship between the gut and skin, sometimes referred to as the gut-skin axis, is complex.
Leaky gut, intestinal inflammation, and imbalances in the gut microbiome have all been linked to eczema.
Identifying food sensitivities or triggers with the help of an elimination diet can help to reduce inflammation and improve both gut health and eczema symptoms.
Additional treatments that target gut health, like probiotics, may also be useful. For a complete plan to restore your gut health, check out my book, Healthy Gut, Healthy You.
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