Often called ” the itch that rashes,” eczema is a skin disorder that typically surfaces in childhood and affects an estimated 10% of the world’s population. At its root, eczema “is an allergic condition that goes on under the surface of the skin,” says Dr. BJ Lanser, a pediatric allergist and immunologist with National Jewish Health in Denver.
The main driver he says, is irritation, scratching or trauma to the skin that activates inflammatory cells in the skin and produces the rash. Symptoms may include dry, itchy skin with red or brownish patches, raised bumps or raw, broken skin, particularly across the cheeks, arms and legs. The itchier the skin gets, the more you scratch and the worse the symptoms get, creating an endless cycle.
Another challenge with eczema is that scratching can introduce bacteria to the skin, which can lead to additional irritation, scarring and potentially more dangerous infections.
While diet is not usually a direct cause of eczema, it’s true that symptoms can be made worse by certain foods. “Eczema is both triggered and exacerbated by the environment, and this includes food exposure,” says Dr. Brian R. Toy, a board-certified dermatologist and attending dermatologist at Mission Hospital in Orange County, California. “While food allergies are rarely the sole cause of eczema, they can contribute significantly to the problem, particularly in children.”
A Challenge in Childhood
Eczema often shows up in infancy or childhood, and this can pose additional challenges to determining which environmental triggers are exacerbating the condition. In infants, especially, eczema can be a real problem. But Therese Ida, a clinical dietitian with National Jewish Health in Denver, says that restricting certain food choices in the mom’s diet isn’t the solution.
“People come in sometimes and they think there needs to be restriction on the mom’s diet because (certain allergens) may show up in the breast milk that could antagonize the child’s reactivity. But that’s not what we find,” she explains. Problematic proteins in potentially allergenic foods mom eats get digested and are unlikely to remain intact enough by the time they reach the breast milk to trigger symptoms in the baby.
That said, if mom is allergic to certain foods or knows that certain foods trigger eczema or another issue in her, she should continue to avoid those items for her own sake. But “we’re not usually looking at any kind of restriction for the mom based on eczema in the child,” Ida explains.
Instead, she says, “we encourage a healthy diet both for the mom’s sake and for the child. The fewer restrictions needed the better.” She notes that nursing women typically need “500 to 1,000 extra calories per day above her own baseline needs” to provide enough energy to make milk to feed the baby.
“So, mom needs to increase her calories and protein content,” by about 20 grams of extra protein per day to support those extra demands on the body, Ida says. This can be done fairly easily by adding another serving of milk or meat and balancing that with fruit, vegetables, whole grains and healthy fats to obtain the extra calories from healthy foods.
Lanser notes that if breastfeeding isn’t possible, you should select your formula carefully to ensure that it doesn’t contain allergens that could trigger symptoms in your baby, as those allergens aren’t first being broken down by mom’s digestive system.
Eating for Eczema Control
In older children who are eating solid foods and adults who struggle with eczema flare ups, keeping an eye on your diet could help you reduce symptoms. However, “determining which foods are contributing to your eczema can be incredibly difficult,” Toy says. “The only way to accurately do this is through an elimination diet, whereby the most likely culprits are completely avoided and then slowly added back in, one at a time over a many-week period while monitoring for symptoms.”
It’s a painstaking process that may not reveal very clear answers because, “unlike classic food allergies, which cause an anaphylactic reaction immediately upon exposure, eczema triggered by food occurs more gradually, and symptoms may not manifest until days after exposure,” he explains.
For many people, eggs, soy and milk can increase symptoms, and Toy says following an anti-inflammatory diet “is a popular trend for those who suffer with eczema.”
An anti-inflammatory diet emphasizes:
— Fruits and Vegetables.
— Whole grains and legumes, such as beans and peas.
— Probiotics, which are found in fermented foods such as yogurt, kefir and kombucha. These so-called good bacteria are “highly anti-inflammatory,” Toy says. They’re also good for supporting gut health and a healthy gut microbiome, which are increasingly thought of as integral to overall health and wellness.
— Flavonoids, which are found in green tea, berries, citrus, red wine and dark chocolate. Found in plants, these compounds also have anti-inflammatory properties.
In addition to whole foods, Toy says anti-inflammatory supplements may also be part of the mix when following an anti-inflammatory diet. These may include:
— Vitamin C. Found in a variety of plant foods, most recognizably citrus fruits, vitamin C helps support a healthy immune system.
— Vitamin D. Humans can manufacture vitamin D in the skin when it’s exposed to direct sunlight. Vitamin D supports bone health and is found in fatty fish, eggs, fortified cereals and fortified dairy products.
— Vitamin E. Vitamin E is an antioxidant that protects cells from damage and can bolster the body’s immune system. Seeds, nuts and leafy greens are good sources of vitamin E.
— Vitamin K. Like vitamins A, D and E, vitamin K is fat-soluble. It promotes healthy blood clotting and can be found in leafy green vegetables.
— Omega-3 fatty acids. Found in flaxseed, chia, fatty fish and other foods, omega-3 fatty acids have anti-inflammatory and heart-protecting benefits.
An anti-inflammatory diet also limits or removes processed foods, which can increase inflammation in the body. While the hard data regarding its effectiveness for eczema is inconclusive, an anti-inflammatory approach to eating that removes processed foods and emphasizes fresh, whole foods is always a good idea.
And Lanser says it’s really important to maintain a healthy diet that includes a wide variety of foods. “Many times, patients have been told to try eliminating wheat or try removing milk. Or try avoiding tomatoes and citrus fruits. So, they come with a long list of foods they’ve removed from their diet. Elimination of these items might improve symptoms for a day or two but the symptoms come back soon thereafter, even with continued avoidance of the food,” he explains.
Healing from Eczema
This all points to just how complicated the connection between food and eczema can be, and underscores that there’s “no magic cure. There’s no single thing that’s going to totally cure the eczema.”
Rather, you have to look at the whole picture, and take a holistic approach to keeping your skin healthy to reduce symptoms. “The most important thing and the key thing with eczema is to focus on good skincare from the beginning,” Lanser says.
Building up the skin’s natural moisture barrier with the use of l otions, daily baths and other treatments can make a big difference, along with eating healthy foods, reducing stress and eliminating exposure to other allergens and environmental triggers.
Work with your doctor to get the right diagnosis and find appropriate treatments. Lanser says you may need to undergo some tests, such as food challenges, to find out what makes your symptoms more pronounced and to make sure there isn’t another skin condition or allergy at work.
Toy agrees that healing from eczema is a process that goes beyond the dinner table. “Eczema is a multi-factorial condition. While diet certainly plays a role, there is interplay with other environmental factors, such as weather and stress.” Successfully managing the condition means “mitigating these environmental factors,” and talking with your dermatologist for treatment and additional guidance.
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