Red, itchy, flaky skin – eczema is no fun. As if my decade long struggle with acne and rosacea wasn’t enough, starting three years ago, I’m now prone to a bit of eczema!
A three-inch patch of my throat made an angry appearance as the weather turned cold that first year and it took me a couple of weeks of disbelief to actually acknowledge what it was. Now, maybe once or twice a year, with a change of season or big stressor that little patch threatens to come out of hiding before I tamp it down.
I know that my tiny little spot is no big deal compared to when you have eczema all over your body and face…but what I’ve learned as an anti-inflammatory dietitian may help you too! So let’s start with the basics.
What causes eczema?
Eczema is a chronic inflammatory skin condition that can be triggered by exposure to allergens or irritants but often, it appears to have no external trigger. Statistics show that between 2-18% of adults have eczema, and it may be on the rise1.
It is thought that there are multiple factors that contribute to eczema, including skin barrier dysfunction, immune factors and environmental triggers, including diet2.
What does the evidence say about eczema and diet?
There is surprisingly little evidence out there on eczema and diet. When I started my research, I did a thorough review of as many PubMed keywords as I could think of, and I couldn’t believe how few trials look at the effect of nutrition and lifestyle on adult eczema. Most studies explore maternal nutrition and early life exposures for young children with eczema and allergy.
What this research does suggest is that we start with the gut. A high fibre diet is well-known to be an an important anti-inflammatory strategy, and this may also be true in eczema3,4.
We also have to consider the role of histamine. Mast cells are immune cells that release histamine; your body’s tolerance to histamine depends on the amount of histamines consumed or released and your ability to enzymatically breakdown released histamines. Increased histamine due to allergy or gastrointestinal inflammation may influence eczema symptoms; one trial found that a low histamine diet improved eczema symptoms5-7.
Gluten, Dairy and Eczema
Because eczema is an allergic type disorder, it makes sense that food allergy can contribute. For example, eczema-like lesions may be a feature of non-celiac gluten sensitivity10. Others report improving their eczema on a dairy-free diet, although the evidence does not yet suggest benefit. While the evidence cannot yet tell us with certainty, it does not hurt to explore your individual reactions but it’s important to do so systematically.
What to eat when you have eczema
Because the research is not strong enough to suggest a specific therapeutic diet for eczema, we need to take a functional approach in supporting digestive and immune health via an anti-inflammatory diet so our body can be as healthy and resilient as possible.
What is an anti-inflammatory diet?
An anti-inflammatory diet is one that is based on whole plant foods like fruits, vegetables, legumes, intact whole grains, nuts and seeds. It means trying to avoid snack foods with refined flours and sugars and going easy on meat and dairy.
I am often struck at how many articles will describe an anti-inflammatory diet as first being ‘soy, gluten, dairy and corn’ free when the vast majority of our inflammatory troubles come from eating hyper-processed and packaged foods – not eating some wheat berries. I believe that the best nutritional solution is the least restrictive one. So start here and for some, this may be all you need to see relief. All of the recipes on this website are anti-inflammatory but if you need more help figuring out how to feed yourself anti-inflammatory meals, order my new book, Eat More Plants!
Fighting histamine with diet
Building upon an anti-inflammatory foundation, you may want to tackle potential histamine issues. An easy way to test whether this is an issue for you? Take an anti-histamine and see if your itchiness goes down. If it does, you might want to introduce some anti-histamine and anti-allergy strategies into your diet.
The first step is consuming more quercetin-rich foods. Quercetin is found in onions, asparagus, kale, broccoli, apples, tomatoes, green tea and berries. Quercetin is thought to help stabilize mast cells to lower histamine levels and inflammation in addition to supporting gut health11.
Eczema Elimination Diets
Next, you may want to try rotating eliminations. I do not recommend going on a restrictive elimination diet unless you A) have tried everything else and B) still have severe eczema and C) are doing so under the guidance of a registered dietitian.
However, rotating eliminations – trying alcohol, gluten and dairy first – isn’t too restrictive and can help you pinpoint how each one affects you. I would recommend strict elimination of a food group for 21 days and then reintroduction of the food to note its effect.
If you feel you need to go further, and suspect that histamine intolerance is an issue for you, know that you probably want to address gut health in general as gut barrier dysfunction and inflammation may be increasing your histamine levels. It may not be the food…it may be that your gut is inflamed and your diet is adding to the histamine load.
Typically, histamine reducing diets are very complex and restrictive and should not be attempted without a skilled dietitian at your side. As an alternative, there is now an enzyme that can break down histamine and it may be worth a try. It’s pricey and it’s animal-source, so I would only recommend it for someone who hasn’t found relief by other means and has significant issues as opposed to a couple little patches.
Supplements for eczema
Probiotics are the first line for my clients with eczema; while the research is still emerging and not all of it is favourable, it appears that probiotics have the potential to improve eczema severity2,8although interestingly, another study found that those with eczema did not seem to be dysbiotic (have imbalanced gut flora)9. I’ve got some advice on how to choose a probiotic here.
It’s worth noting that probiotics may also contribute to histamine levels so if you’re struggling with histamine as your primary issue, you may need to remove your probiotic.
While little clinical evidence supports its effectiveness in eczema, I still think that a high dose omega 3 supplement is worth trying…because it certainly won’t hurt!
Vitamin D is another consideration as we know that vitamin D supports the immune system. Very little research has been done, however, one trial found that 1600IU of vitamin D3 daily helped lower disease severity2. While one trial isn’t enough to speak with confidence, we know we need to take vitamin D anyways…so this is a reminder to take your daily dose!
Treat the Whole Person
Any disorder of our gut-brain-skin connection is complex, eczema is just one example of this. While the research catches up, the best we can do is support our immune systems with the best possible anti-inflammatory nutrition. Pile your plate with plants, sleep well, move your body and take measures to manage stress.
1.Ridd, M J et al. “Systematic review of self-management interventions for people with eczema.” The British journal of dermatologyvol. 177,3 (2017): 719-734. doi:10.1111/bjd.15601
2.Schlichte, Megan J et al. “Diet and eczema: a review of dietary supplements for the treatment of atopic dermatitis.” Dermatology practical & conceptual vol. 6,3 23-9. 31 Jul. 2016, doi:10.5826/dpc.0603a06
3.Neerven, R J J van, and Huub Savelkoul. “Nutrition and Allergic Diseases.” Nutrients vol. 9,7 762. 17 Jul. 2017, doi:10.3390/nu9070762
4.Bach Knudsen, Knud Erik et al. “Impact of Diet-Modulated Butyrate Production on Intestinal Barrier Function and Inflammation.” Nutrientsvol. 10,10 1499. 13 Oct. 2018, doi:10.3390/nu10101499
5.Chung, Bo Young et al. “Treatment of Atopic Dermatitis with a Low-histamine Diet.” Annals of dermatologyvol. 23 Suppl 1,Suppl 1 (2011): S91-5. doi:10.5021/ad.2011.23.S1.S91
6.Fabisiak, Adam et al. “Targeting Histamine Receptors in Irritable Bowel Syndrome: A Critical Appraisal.” Journal of neurogastroenterology and motilityvol. 23,3 (2017): 341-348. doi:10.5056/jnm16203
7.Enko, Dietmar et al. “Concomitant Prevalence of Low Serum Diamine Oxidase Activity and Carbohydrate Malabsorption.” Canadian journal of gastroenterology & hepatologyvol. 2016 (2016): 4893501. doi:10.1155/2016/4893501
8.Makrgeorgou, Areti, et al. “Probiotics for treating eczema.” Cochrane Database of Systematic Reviews11 (2018).
9.Hua, Xing et al. “Allergy associations with the adult fecal microbiota: Analysis of the American Gut Project.” EBioMedicinevol. 3 172-179. 27 Nov. 2015, doi:10.1016/j.ebiom.2015.11.038
10.Bonciolini, Veronica et al. “Cutaneous Manifestations of Non-Celiac Gluten Sensitivity: Clinical Histological and Immunopathological Features.” Nutrientsvol. 7,9 7798-805. 15 Sep. 2015, doi:10.3390/nu7095368
11.Shigeshiro, Mizuki, Soichi Tanabe, and Takuya Suzuki. “Dietary polyphenols modulate intestinal barrier defects and inflammation in a murine model of colitis.” Journal of Functional Foods5.2 (2013): 949-955.