Eczema - Is it Linked To Diet?
Related article: Eczema
Eczema is a very common allergic skin condition where patches of skin become red, itchy and inflamed. Sad to say that it has been estimated to affect up to 15 million people in the UK and 31.6 million in the US suffer from different stages and types of eczema (1, 2).
Although diet does not directly cause eczema but by having a good diet can prevent flare-ups and is key to overall condition management. It is important to address that healing not only your skin but also your entire immune system will take TIME. You may be discouraged along the way but it’s never a reason to give up!
Foods are among the many environmental factors that can exacerbate eczema symptoms especially when your body is allergic or sensitive to that food (3). Not everyone with eczema suffers from food allergies but it does come hand to hand with eczema. 37% of children with moderate to severe eczema also have food allergies (4).
Note when food allergy comes back negative, you can still be sensitive or intolerant to certain foods (5).
The mentioned foods in our diet contradict with popular beliefs but actually can trigger a maddening itch in those with eczema.
Other food triggers
Monosodium glutamate (MSG)
Note: not all items on this list should be avoided. Triggers vary for everyone as some may be well tolerated by some while others react adversely towards them. To test what foods can be tolerated, try the elimination diet below.
According to the food allergen labelling and consumer protection act of 2004 (FALCPA), the following foods account for 90% of all food allergies and sometimes referred to as The Big-8 (6).
The majority of food allergic reactions are triggered by (7):
Check gluten-free diet tips
Coeliac disease seems to go hand in hand with people with eczema due to the genetic link.
#1 Wheat or specifically, gluten
Research has shown that gluten is one out of eight allergens responsible for 90% of food allergic reactions (8). Not everyone is sensitive to gluten but if you have trouble digesting bread, pasta or pizza and have stomach problems afterwards, you might see great results from going on a gluten-free diet. This is because gluten can trigger an immune response that can lead to eczema flare-ups.
Substitute with: Luckily, most products now have gluten-free substitutes that are readily available at your supermarket. Gluten-free whole grain substitutes you can try are quinoa, millet, amaranth, buckwheat and sorghum.
#2 Dairy products
Milk, cheese, yoghurt, butter
The first case report from 1997 was when an adult was introduced to a lactose-free diet resulting in a complete disappearance of eczema and no longer needed to use steroid creams (9). Since then, more studies have been done and results have shown that by simply removing lactose or dairy products from their diet has significantly improved their condition (10, 11).
However, studies reported that children consuming milk had a lower risk of eczema (12) and consuming raw milk actually protects against asthma and allergies (13, 14). This may be due to the benefits that raw milk carries. Although these carry the risk of contamination, they are easier to digest compared to pasteurised milk and may be more beneficial due to the probiotics and enzymes.
Pasteurised milk changes the structure of milk proteins that your body cannot process and destroys natural probiotics and enzymes present (15).
Though many raves about raw milk, more scientific data is needed to support these claims.
Substitute with: Rice, oat, coconut, flaxseed, hemp alternatives for milk, yoghurt and cheese. Vegetable oil, olive oil, coconut butter for butter.
Chicken, quail, goose, duck eggs
Among food allergies, egg allergy is very common (16). Luckily two-thirds of the children will outgrow this allergy by 5 years old (17).
#6 Tree nuts
Almonds, brazil nuts, cashews, chestnuts, filberts, hazelnuts, macadamia nuts, pecans, pine nuts, pistachios and walnuts
Nuts and tomatoes are major allergens and regular consumption of nuts is associated with eczema (19, 20).
Most food allergies eventually resolve but allergies to peanuts and tree nuts tend to persist (21).
Substitute with: pumpkin seeds, sunflower seeds, flax seed, hemp seed, peas, chickpeas
Tofu, soy milk, seitan, miso, tempeh, edamame and many processed foods
People allergic to cow’s milk tends to be allergic to soy milk as well due to the close resemblance between the proteins (18).
Soy is a very common texturizer, emulsifier and protein filler and is hidden in many products so it’s best to stick to a whole foods-based diet.
Here’s a list of hidden names for soy.
cakes, sodas, smoothies, candies, fast food items and high-glycaemic foods
There are certain foods that trigger eczema flare-ups like sugary desserts and candy. The theory behind this is that high sugar intakes cause insulin levels to spike resulting in inflammation (22). High glycaemic foods also cause the surge in insulin levels, so it is recommended to avoid those.
Studies suggest otherwise. There are no studies that support this theory and in fact, in one study after an elimination diet, there were insignificant differences in children with atopic eczema (23).
However, anecdotal evidence would suggest that some people have experienced a decrease in symptoms. This could be due to their improvement in gut health which contributes to overall wellbeing.
Substitute with: plant-based sugar like coconut sugar (low GI), stevia, monk fruit sugar or miracle berry (miraculin) in moderation.
tomatoes, tomatillos, eggplants, white potatoes, goji berries, tobacco, peppers (bell, chilli, paprika, tamales, tomatillos, pimentos, cayenne, etc.)
These vegetables may not seem to have anything in common but most nightshade vegetables have a cute little green elf hat (potatoes are the exception).
Nightshades contain low-level toxins, glycoalkaloids like solanine, capsaicin, nicotine and tropane, which some people are allergic or sensitive to (24).
Potato starch can be used as a thickener or filler in medications, baking powder and envelope glue. These should be avoided when going on the elimination diet.
Substitute with: sweet potatoes and yam, cauliflower, celery, radishes, fresh fruits, mushrooms, black and white pepper.
Oranges, lemons, limes, grapefruits, pineapple
According to the NHS, 10% of cases are triggered by foods milk, eggs, citrus fruit, chocolate, peanuts and colourings (25).
People can be diagnosed with citrus intolerance and have adverse reactions to the fresh fruit, juice or the peel.
Substitute with: champagne and sherry vinegar
Sugar, bread, dairy products, meat, processed foods, alcohol
In one study, they observed significant differences in skin pH in children with eczema and children with healthy skin (26). This suggests that having a body too acidic or alkaline can cause eczema to flare.
Once food is ingested and metabolised in our body, it leaves either an acidic or alkaline residue. It is important to maintain a balance between these two extremes. The typical American diet leans toward the acidic side and hence, altering to a more alkaline diet may help lessen the symptoms.
It is said that a balance of 80% alkalizing food and 20% acid foods is ideal (27).
However, there is no scientific proof that acidic foods are a trigger for people with eczema.
Apples, apricot, avocados, most berries, cherries, dates, grape, guava, kiwi fruit, oranges, pineapple, peaches, plum, dried fruits
Cauliflower, cucumbers, endive, gherkin, mushrooms, radishes, aubergine, spinach, zucchini
Aniseed, canella powder, cayenne, celery powder, cinnamon, curry, dill powder, fenugreek powder, garam masala, mustard powder, oregano, paprika, rosemary, sage tarragon, turmeric, thyme, mink, black pepper, bay leaves, basil, caraway, ginger root and nutmeg
Almonds, brazil nuts, pine nuts, pistachio, sesame seeds, peanuts and pumpkin seeds, water chestnut
Coconut oil, olive oil, honey
Aspirin Medications such as aspirin is the largest source of salicylates.
Salicylates are natural plant chemicals found in many fruits and vegetables, medications and cosmetics (28). Sometimes a small dose can cause problems in those with salicylate intolerance or salicylate sensitivity. In fact, 52% of patients with eczema are sensitive to salicylates (29).
A trial on a salicylate restricted diet may be of benefit for those who have found no relief from other treatments (30).
However, no scientific evidence has proven that by going on a low-salicylate diet can improve symptoms (31).
In fact, 74 children prescribed on the elimination diet for salicylates suffered from nutrient deficiencies, food aversion and eating disorders (32). As this a highly restrictive diet and hardly sustainable, it should not be recommended for children during their developing years.
fermented food: sauerkraut, yoghurt, kombucha, soy sauce
fermented drinks: wine, champagne, beer
vegetables: avocados, eggplant, spinach and tomatoes
smoked fish: mackerel, tuna, anchovies, sardines
Histamine is produced during an allergic reaction which can give you puffy eyes and itchy skin. Therefore, antihistamines are sometimes prescribed for eczema sufferers.
Foods naturally high in histamine would hence mimic the symptoms observed in an allergic reaction if circulating levels are kept high. People with a histamine intolerance due to the deficiency of enzymes involved in the process of histamine degradation such as the diamine oxidase (DAO) enzyme will result in the build-up of histamine (33, 34). Symptoms of eczema flare-ups will then occur from time to time.
A 6-year-old boy suffering from eczema maintained a low-histamine dietary regimen recovered from all symptoms after 7 months (35).
In another study, 12 of the 36 participants improved their skin statuses after following a histamine-free diet for 7 days. After two weeks, the reintroduction of histamine by using histamine-di-hydrochloride capsules actually aggravated the symptoms in participants with eczema. Overall, 30% of patients from the trial benefitted from a histamine-free diet (36).
This suggests that following a low-histamine diet possibly could help with maintaining the symptoms.
Monosodium glutamate (MSG)
natural sources: Bone broths, braised meat, broccoli, fish sauce, grape juice, mushrooms, peas, soy sauce, tomatoes, walnuts, wheat
processed foods ingredients: natural flavour, protein isolate, soy extract, yeast extract, hydrolysed yeast, autolysed yeast, hydrolysed vegetable protein
35% of eczema sufferers have a worsening of eczema symptoms when monosodium glutamates (MSG) are consumed (37).
These are naturally found in many plant sources and in many processed foods as flavour enhancers giving that “umami” taste.
Natural sources of glutamates bound to proteins are generally digested and absorbed slowly whereas free glutamates found in processed foods can cause spikes in glutamate levels in the blood.
Glutamate acts as a neurotransmitter and excess concentrations are associated with migraines, multiple sclerosis, Alzheimer’s disease, stroke and a number of mental health disorders (38).
You can eat more foods packed with anti-inflammatory compounds to strengthen your immune system. It is important to consume enough of these, especially if you are prone to inflammatory skin conditions like eczema, contact dermatitis, hives and psoriasis.
Probiotics are our beneficial bacteria found in many fermented foods. These may reduce flare-ups and allergic reactions.
These are found in sauerkraut, kefir, tempeh, kimchi, natural yoghurts and many other products.
There are some promising results from the use of probiotics and prebiotics taken in combination (39). More studies are needed to clarify the dose and strain of probiotics.
However, if you are sensitive or intolerant of salicylate, then avoid these fermented foods and take a salicylate-free probiotic supplement instead.
Some yoghurts are particularly bad for eczema as it often is loaded with added sugar, fruit flavourings, amines (histamines from fermentation) and a natural colour called Annatto (160b) which can trigger eczema (40).
Omega 3 fatty acids
Omega-3 fatty acids are widely known for their numerous health benefits. There are a few types of omega-3 fatty acids such as the short chain alpha-linolenic acid (ALA), and long chain eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).
Alpha-linolenic acid (ALA) is mainly obtained from plant sources such as rapeseed oil, walnuts, flaxseeds, chia seeds, hemp seeds, pumpkin seeds and tofu all of which are suitable for vegans and vegetarians.
Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are found in algae oil, krill oil and oily fish including salmon, sardines, trout, anchovies, herring and mackerel.
Note that alpha-linolenic acid (ALA) though is an essential fatty acid, must be converted into longer-chained eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in order for the body to synthesise. However, less than 5% of ALA is converted into the longer chain versions that your body requires (41). Therefore, consuming foods containing EPA and DHA is the best way to increase levels of these omega-3 fatty acids in your body.
Rapeseed oil, walnuts, flaxseeds, chia seeds, hemp seeds, pumpkin seeds and tofu
Algae oil, krill oil, oily fish (salmon, sardines, trout, anchovies, herring and mackerel)
Diets high in omega-3 fatty acids may play an important role in dampening inflammation by producing anti-inflammatory agents called prostaglandins and reducing leukotriene B4 (42).
Regardless that there is no convincing evidence of the benefits of omega-3 fatty acid supplementation in eczema, most health organisations suggest 250-500 mg of combined EPA and DHA each day for healthy individuals (43). Higher amounts are recommended for those with health conditions.
Gamma linolenic acid (GLA)
While most omega-6 fatty acids promote inflammation, one particular type is known as gamma-linolenic acid (GLA) actually plays an important role in modulating inflammation and skin health.
This is found in borage oil (starflower oil), black currant seed oil, and evening primrose oil often taken in capsules. GLA enriched oils were shown to help prevent water loss from cells in people with dry skin conditions and mild atopic dermatitis (44).
improve the roughness, elasticity, and firmness of In addition, GLA supplementation can skin (45).
The reason behind low levels of GLA typically found in those with eczema could be caused by the enzyme known as delta-6-desaturase (D6D) which is essential in the conversion of linoleic acid (LA) to GLA (46). This defect or deficiency of this enzyme in some people and can lead to the deficiency of GLA formed in the body. As GLA plays a role in the structural component of cell membranes to ensure fluidity and stability, insufficient levels can result in skin disorders (47).
Although evidence isn’t conclusive, GLA may be helpful to some people with less severe atopic eczema (48).
However, it is recommended NOT to take omega 6 fatty acids if you have seizures and NOT to take borage oil if you are pregnant (49).
Note that actual allergies which are life-threatening should not be confused with possible eczema triggers. Remember that no food need be completely off-limits unless you are truly allergic to it.
You might be thinking, “What can I eat then?” Well, everyone’s different and removing all these food items is extremely difficult to achieve an overall balanced diet. A practical approach is to try the elimination diet proven successful in some cases (50).
Keep a food diary and note down each time you encounter a flare-up. Once you have an idea of what triggers your eczema, you can start to make some progress in avoiding future flare-ups.
Start by removing suspected foods or food groups from your diet for two weeks and see if flare-ups subside
Reintroduce these foods one at a time and watch for any reactions. Symptoms can take a few days to appear.
If symptoms do occur, you can determine which foods are contributing to the symptoms.
If no symptoms occur, these food items can be gradually added back to the diet.
Suspected food and items:
common food allergens (eggs, fish, seafood, nuts, peas, beans)
specific chemical substances in foods, personal hygiene products and medications (naturally occurring or added; salicylates, benzoates, penicillin, yeast and tartrazine) (51)
This is not forever, this is a chance for your body to heal and boost energy. Once your skin is cleared up, you can start to reintroduce these foods.
Note that removing nutritious foods from the diet means that you need to substitute with one that is equally healthy. Don’t starve yourself as your body needs nutrients to rebuild itself. Hence, this process is best done and supervised by a registered dietitian!