topic eczema (AE) is an atopic condition with a genetic component. It is usually categorised as a Type 1 Hypersensitivity allergic reaction involving an abnormal immune response to a substance which would usually be considered harmless. In the atopic individual; antigens ingested due to dust mites, molds, dander or chemicals, trigger an immune response. Histamine and other chemical mediators are released from the granules of mast cells. Inflammation, vasodilation and increased capillary permeability occurs. Sedentary lifestyles and children spending more time indoors in an urban environment contribute to the rise in exposure to allergens due to poor ventilation. Increased air pollution may also contribute (Gould 2006).
Common causes of skin conditions and eczema
The most common causes of skin conditions include;
Allergy; most commonly to wheat and dairy.
Low hydrochloric acid levels and incomplete digestion.
Sub optimal levels of water intake and fibre in the diet leading to poor elimination.
Risk factors for skin conditions
Children from clean indoor urban environments may be at risk of developing allergic conditions. The ‘Hygiene Hypothesis’ postulates that exposure to antigens in the first year of life is essential to the development of immune competence; defined as a balance of Th1 and Th2. Infants exposed to natural environments like the countryside, animals and other children are less likely to develop allergies. Infants kept in sterile urban environments are more likely to lack the acquired programming which suppresses immune response to ingested antigens and are therefore more likely to suffer with AE and other allergic conditions (Jones 2010).
The occurrence of atopic conditions is very much on the increase, particularly in developed countries. The more educated the mother and the more affluent the social class the more likely it is that atopy may occur. In many ways it may be understood as a disease of modernity: leading to decreased Th1 and subsequently increased Th2 type inflammation; and advancing allergic conditions (Hussain 2004).
Breast feeding infants reduces the risk of eczema and administering probiotics to the mother and nursing baby has shown positive results in reducing symptoms. Foods such as cow’s milk, milk products and eggs should not be given to children under one year of age (Lipski 2012).
Repeated use of antibiotics or alcohol can contribute to dysbiosis.
Inflammation is present and has usually become chronic.
Individuals with a poor diet and sedentary lifestyle are at risk.
The Digestive System and Skin Conditions
Gastrointestinal imbalance, known as dysbiosis, is a condition caused by the overgrowth of bacteria, yeast, and parasites and is associated with symptoms such as cramping, cystic acne, fatigue, food sensitivities, gas and skin conditions. It may be caused by an insufficiency of beneficial microflora in the gut following repeated antibiotic use, or by a low fibre diet. Insufficiency dysbiosis is often found in individuals with food sensitivities and is commonly associated with putrefaction dysbiosis. Fungal dysbiosis is promoted by sugar, alcohol and antibiotics and the yeasts may be found on the skin in cases of psoriasis. Fungal and fermentation dysbiosis are usually found side by side. Bacteria in our gut form gas as the by-product of fermentation following the consumption of carbohydrates. Consuming large quantities of sugar, alcohol and starchy vegetables or grains contributes to symptoms associated with gas such as bloating, trapped wind and a crampy painful sensation (Lipski 2012).
Poor detoxification and elimination is a factor in eczema, psoriasis and acne.
Gastrointestinal insufficiencies such as low digestive enzymes and hydrochloric acid contribute to incomplete digestion. (Langley 2007).
Intestinal putrefaction occurs when protein digestion becomes incomplete due to inadequate quantities of digestive enzymes, hydrochloric acid (HCL) and probiotic bacteria.
Intestinal toxaemia contributes to acne, with individuals with severe acne showing increased reabsorption of toxins from the intestines (Murray 1998).
Psoriasis in particular is associated with incomplete protein digestion and absorption; producing toxic metabolites in the bowel known as polyamines. Polyamines contribute to the excessive rate of cell proliferation in psoriasis (Murray 1998).
A high level of bowel toxins, which may constitute components of bacteria, yeasts, and immune complexes, is associated with an increased rate of proliferation in psoriasis and is the underlying mechanism in the pathophysiology of psoriasis (Murray 1998).
Eczema and Stress
Chronic eczema is exacerbated by both physical or emotional stress.
When a stressor is present; the eczema may become more acute according to our reaction to the stress. In order to avoid stress becoming a causative factor, positive stress coping techniques and an adequate support system are recommended (Gould 2006)
Psoriasis occurs when skin cells mature too quickly. Like eczema, there is a genetic component, and flare ups may be triggered by stress. Individuals with psoriasis have an excess of T-helper cell (Th-1) inflammatory cytokines and relatively few Th-2 cytokines. The condition is associated with leaky gut, dysbiosis, inflammation, antigens, insulin resistance, impaired glucose tolerance, obesity, liver disease, high cholesterol and/or triglycerides. Intestinal permeability, celiac disease and gluten sensitivity are often seen with cases of psoriasis (Lipski 2012).
Why are more people suffering with skin conditions now?
Industrialised food production practices and modern lifestyles have by turn reduced the nutritional profile of our everyday diet and increased the demands we place on our bodies.
According to Dr Lipski, skin conditions such as eczema are on the rise in industrialised countries due to the prevalence of imbalanced intestinal flora, leaky gut syndrome, food allergies, environmental contaminants, air pollution, tobacco smoke, genetic predisposition and fungal infections such as candida albicans.
How much of a role does nutrition play in skin health?
Nutrition plays a critical role in skin health. An anti-inflammatory diet with the elimination of food allergens is the most successful protocol. Abundant fruit and vegetables provide antioxidants, vitamins, minerals and fibre. A focus on the inclusion of essential fatty acids from oily fish, walnuts, chia seeds or flaxseeds provides a balanced ratio of omega-3 to omega-6; increasing the production of anti-inflammatory prostaglandins.
How can we improve our skin health through gut health support?
High fibre foods, fruit and vegetables are recommended in order rebalance this pattern of dysbiosis (Lipski 2012).
The most typical dietary drivers of atopic eczema (AE) are the combination of a reaction to wheat or dairy and an EFA deficiency. The recommended therapeutic diet for skin health is predominantly vegan with fish, avoiding processed red meat and non organic dairy.
Low in salt but with good levels of EFAs. Cleansing diets and elimination diets may be necessary. In addition, good levels of fiber, water, antioxidants A, C and E, B6, biotin, zinc and magnesium are essential (Holford 2004).
Nutritional approaches to skin conditions include a protocol known as the Functional Medicine 5R model; this protocol resolves any gastrointestinal imbalance by means of the following stages;
Remove: Eliminate pathogenic yeast and foods or additives which may trigger an immune response.
Replace: Digestive enzymes, HCL
A nutritionist will be able to recommend a comprehensive digestive stool analysis or an allergy testing or guided elimination diet. Elimination of foods which cause an immune reaction will cause the client to feel immeasurably better and allow the body to recover using its own rebalancing mechanisms. It usually takes around 4-6 months for a full elimination to yield results; so some patience and commitment is needed by both the client and the practitioner.
Check your stomach acid!
Food allergies and eczema are associated with sub-optimum gastric acidity. Hypochlorhydria is a condition whereby a reduced amount of gastric acid is secreted by the parietal cells which line the stomach. It is associated with chronic inflammation and triggers bacterial overgrowth in the small intestine. Subsequently, the digestion and absorption of folate, B6 and B12 may be severely compromised. (Liska 2004).
Nutritional protocols for skin conditions
Low enzyme output compromises digestion and is associated with eczema and food allergies. Digestive enzymes metabolise proteins and other large molecules within food and prevent them from inappropriately crossing the intestinal lining (Liska 2004).
Removal of dietary allergens
The primary therapeutic aim is to identify and eliminate foods causing the allergic response. Food allergy may be diagnosed by eliminating a food item from the diet for a minimum of ten days and then reintroducing the item, watching carefully for adverse reactions. The majority of atopic eczema cases improve by the elimination of allergenic foods from the diet (Murray 1998).
Rebalancing the gut flora
Candida may inhibit the activity of suppressor cells and contribute to the issues with antibodies in atopic eczema. Removal of sugar, caffeine and alcohol from the diet and reducing stress helps to promote a healthy bacterial environment which denies Candida the opportunity to root in the mucosa. This is an additional preventative measure against leaky gut. A strict anti-Candida diet involves removing the following for at least four weeks; sugar, fruit, yeast, refined grains, stimulants, mushrooms, and fermented foods. Recommended supplements include a good probiotic and an initial dose of 400mg/day Caprylic acid, working up from there when levels of die off are felt to be manageable. Other antifungals which may be used are; Oil of Oregano, Berberine, Grapefruit seed extract, Pau D’Arco and garlic (Langley 2007). Saccharomyces Boulardii is also very successful in treating an individual with suspected candida overgrowth.
In clinical trials, probiotics given to pregnant women and to neonates decreased the occurrence of atopic conditions. This suggests that treating the gastrointestinal system may be critical in re-establishing immune tolerance and potentially reversing AE symptoms (Jones 2010). Probiotic bacteria, particularly Lactobacillus GG, may be effective in the prevention of atopic conditions like AE, even when atopy is in the family history. Clinical trials have demonstrated that probiotics may as much as half the likelihood of developing AE if given prenatally to the mother and postnatally to infants. The importance of gut microflora in the treatment of AE is an area of promising research and early results indicate that treating the gut may have extremely beneficial consequences for individuals with AE (Kalliomäki et al 2001).
Individuals with eczema may have unique patterns of fatty acid composition (Liska 2004). Furthermore, they tend to exhibit unique essential fatty acid (EFA) and prostaglandin metabolism. Linoleic acid levels tend toward being relatively high whilst gamma-linoleic acid (GLA), eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA) tend towards being decreased. The disruption of the balanced EFA ratio promotes further susceptibility towards allergic reactions and chronic inflammation (Murray 1998). It is established that fatty acids have a deep and fundamental effect on the inflammatory mediators and are often deficient due to the modern Western diet being significantly lower in omega-3 compared to our ancestral diet. EFA dietary status is therefore significant to the pathogenesis of atopic eczema (Jones 2005).
Supplementing fish oils containing EPA and DHA is known to rebalance prostaglandin irregularities. A fish oil supplement or the regular consumption of oily fish such as salmon, sardines, mackerel or herring, enhances cell membrane levels of omega-3 fatty acids and is a crucial therapeutic measure for any client with an inflammatory imbalance. Due to the therapeutic efficacy being dependent on the increase of DHA in serum phospholipids; direct EPA and DHA sourced from fish oils has proven to be more effective than alpha-linolenic acid; commonly sourced from flax or flaxseed oil (Murray 1998).
What lifestyle factors play a role?
Chronic eczema is exacerbated by stress, either physical or emotional; when a stressor is present the eczema may become more acute. Stress may be envisioned as a ‘social pollutant’ that when allowed into the body may disrupt inflammatory processes (Wright 2005). Furthermore, the itching is promoted and enhanced by emotional tension and individuals with AE may be more susceptible to anxiety, hostility and neurosis (Murray 1998).
Calming the mind and a positive mental attitude are beneficial to resolving stress levels. Lifestyle approaches include addressing time management and relationship issues, an exercise program, a nourishing and healthy diet and supplements or elements in the diet which support the adrenal glands. (Murray 1998). Exercise decreases the inflammation associated with eczema by improving the body’s adaptability to stress (Lipski 2012).
Switch to organic foods and use only natural cleaning products in your home. Removing or hoovering carpets and wearing natural fibres is a useful approach, and removing antiperspirants and perfumes is an important step to remove chemicals from your body and environment.
Nutritional approaches to skin conditions have been well researched and documented during the last 20 years. It is however and relatively new science and more studies are needed to gain further understanding in this emerging field.
Murray M and Pizzorno J (1998) Encyclopedia of Natural Medicine, revised 2nd edition, New York, Three Rivers Press
Gould (2006) Pathophysiology for the Health Professions, Philadelphia, Saunders Elsevier
Hussein I and Kline J (2004), DNA, The Immune System, and Atopic Disease, The Journal of Investigative Dermatology, 9(1):23-8, [online] Available at: http://www.ncbi.nlm.nih.gov/pubmed/14870981
Jones DS ed (2005) Textbook of Functional Medicine, WA, The Institute for Functional Medicine
Langley S (2007) The Naturopathy Workbook, U.K. The College of Naturopathic Medicine
Lipski E (2012) Digestive Wellness, 4th edition, USA, McGraw-Hill
Liska D et all (2004) Clinical Nutrition: A Functional Approach, USA
Wright R, Cohen R and Cohen S (2005), The Impact of Stress on the Development and Expression of Atopy, Current Opinion in Allergy and Clinical Immunology, 5:23-29, [online] Available at: http://www.ncbi.nlm.nih.gov/pubmed/15643340
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