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  • Writer's pictureImogen Tingay

Eczema Elimination diets - Why cutting back is setting you back

Updated: Apr 4, 2023

Eczema, also known as atopic dermatitis, is a condition that affects millions of people worldwide and leaves a lot of us feeling lost when trying to manage it. This is partly because the exact cause of eczema is not fully understood. Whilst genetic and environmental factors certainly play a role, for most people their first thought turns to the food their eating and whether or not they have an allergy or sensitivity.


For some people with eczema, eliminating certain foods from their diet can be helpful in reducing their symptoms if its done in a controlled manner with the help of a dietitian. A true elimination diet will take one particular food e.g dairy, and eliminate it from the diet over a course of 2-4 weeks. This is usually after a food-symptom diary has been kept for at least 2 weeks and a clear correlation between flaring and the food has been identified. If no improvement is seen in the time that the food has been eliminated, the food can then be reintroduced slowly and carefully. If there is no reaction, it can be concluded that the patient does not have a sensitivity or intolerance and the food can remain in the diet. Only then would you move onto the next food group that is suspected of causing an issue.

 

Unfortunately, most people get the fear (I’ve been there too) and start to take out all the known allergen foods e.g. dairy, gluten, soy, peanuts, nightshades ect in a desperate attempt to control their inflammation and flaring. The purpose of this blog post is to educate you on why that might not be the best course of action…


1. Nutritional deficiencies

Eliminating foods from you diet can lead to nutritional deficiencies which can have negative impacts on your health. For example if you eliminate dairy products from your diet, you may not be able to reach your daily calcium goals. Well can’t I just have plant milks instead you ask? Of course! However, if you have included soy, nuts and gluten in your list of foods to avoid, that rules out soy milk, oat milk and almond milk. Similarly, if you eliminate wheat and nightshade vegetables from your diet, you will be lowering your intake of fibre which is essential for improving your gut health and ultimately overall health.


2. Incomplete Diagnosis

If you only focus on eliminating certain foods from your diet without addressing other factors that may be contributing to your eczema, you may not see significant improvement in your symptoms. For example, if you’re allergic to dust mites (as is the case with me), eliminating dairy from your diet probably isn’t going to have any impact on your eczema symptoms.


3. Psychological Impact

The strain of eliminating foods from your diet and restricting your intake so severely can make every day a challenge. Having chronic eczema is burden enough and putting added pressure that could also impact your social life will be detrimental to your mental health – especially if its your favourite foods you’re eliminating! It is important to have a support system in place when making changes to your diet. This can include friends and family who understand your situation and can accommodate you on social visits, as well as a healthcare professional such as a dietitian to provide support and guidance.


4. Difficulty in identifying trigger foods

Identifying trigger foods is very tricky as an eczema flare may not happen instantly after consuming a trigger food. This is known as a non-IgE reaction in the allergy sense but can also be the same for an intolerance. An intolerance is when your body has trouble digesting a certain aspect of the food you've eaten e.g. lactose or gluten and can happen several hours after ingestion. In an allergy, it is the protein within the food that is causing the problems e.g. casein in cows milk or Ara h 1 in peanuts. The immune system mistakenly identifies these proteins as a threat. For this reason, eliminating multiple foods all at once can make it even more difficult to identify which food is the troublemaker. It’s important to keep a food diary to help identify any patterns between your diet and eczema symptoms and then work with a dietitian. For an intolerance you're looking for symptoms such as diarrhoea, bloating, gas and tummy pain. For an allergy, you're looking for signs of wheezing, lip swelling, hives and increased itchiness - although this is a difficult one to track if you're already flaring.


5. Lack of evidence

While some studies have suggested a link between certain foods and eczema, the evidence is not conclusive. Therefore, eliminating foods from your diet may not always provide the desired results. Providing your body with an abundance and variety of foods you will be ensuring that you will be receiving the nutrients and fuel your body needs to support itself. The current evidence emerging concerning the gut-skin axis is promising and calls for a focus on increasing foods in the diet to support skin healing, not eliminating.


6. Increasing risk of developing intolerance

There is now emerging evidence that shows the longer these foods are left out of the diet, the more you are to develop an intolerance to them. The opposite of what you’re hoping to achieve. It can also be possible to develop a temporary intolerance to certain foods when your gut is inflamed and damaged. For example, a damaged gut will stop producing lactase efficiently and as a result, stop being able to digest lactose, resulting in a lactose intolerance. In these situations, addressing the underlying gut health issues should clear up the intolerance. In the case of an overactive immune system, allergies can develop. Once the immune system is brought back into balance, the allergy can resolve. Through childhood up to my early twenties, I was allergic to horses, dogs, cats, rabbits, guineas pigs, hay, straw, dust, peanuts, latex and rubber. I'm now only set off by dusty environments and latex.

 

It is important to remember that everyone’s eczema is different and what works for you, may not work for another and vice versa. It’s sometimes a hard pill to swallow when you’re playing witness to someone’s healing and not seeing the same results in yourself. Also, if you have a confirmed allergy e.g. cows milk protein allergy, please do not try to keep eating the food and allergies are different to intolerances and you may end up damaging the gut further!

I’m hoping the above information has come as a relief to most of you. Yes, you can eat the cheese IF its not causing you to flare! But if you’re still feeling lost, here are some things to focus on;


· Eat a variety of fruits and vegetables – Fruits and vegetables contain a wide range of vitamins, mineral and antioxidants that support skin health as well as high fibre to support gut health. The more the better! Aim for your good ole 5-a-day.

· Incorporate omega-3 fatty acids: omegas-3 fatty acids have anti-inflammatory properties that can help reduce skin inflammation. Foods rich in omegas include chia seeds, flax seeds, hemp seed oil, walnuts, olive oil and fatty fish such as sardines and salmon.

· Choose whole-grains: Whole grains, such as whole wheat bread, brown rice and quinoa, contain the fibre your gut bacteria need to thrive and produce the short chain fatty acids than enable our bodies to function optimally.

· Stay hydrated – Keep chugging down the water and download my free skin hydration PDF for some more tips!

· Consult with a registered dietitian!


No, it doesn’t have to be me if you don’t want it to be… If you’re unsure about what to eat or you suspect you do have an intolerance, working with a dietitian to create a personalized nutrition plan will be beneficial. I appreciate this is a long blog post so if you’ve got this far, I thank you and I hope its shed some light on the issues surrounding elimination diets.


Throughout my eczema filled childhood, I didn’t cut out any food groups because I didn’t have to. During TSW, I tried to cut out dairy and gluten but neither made any improvement to me. If you aren’t in a position to see a dietitian, follow the tips above or keep a 2-week long food-symptom diary and see what you find! Work on supporting your gut health and immune system. I will be posting a lot more general health tips on my Instagram so be sure to keep an eye on things over there too.


Remember, I am now in the process of making a waiting list for when my consultations open in June so please do get in touch if you’d like to be on it! In the meantime, you can sign up to receive my free Skin hydration PDF over on the home page!


Happy Tuesday!!











References

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Carol R. “Are you a rash whisperer?” Dermatol World. 2019:29(1):44-9.

Mowad CM, Anderson B, et al. “Allergic contact dermatitis: Patient diagnosis and evaluation.” J Am Acad Dermatol. 2016;74:1029-40.

Mowad CM, Anderson B, et al. “Allergic contact dermatitis: Patient management and education.” J Am Acad Dermatol. 2016;74:1043-54.

Usatine RP and Riojas M. “Diagnosis and management of contact dermatitis.” Am Fam Physician. 2010 Aug 1;82(3):249-55.


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