Eczema & nutrition — strategies for adults
What is Atopic Eczema?
Atopic eczema (also called atopic dermatitis), is a chronic, itchy and inflamed skin condition that is not contagious. It affects 5-20% of the population at some point in their lives, often beginning in childhood.1, 2
Atopic eczema is caused by a combination of genetic, environmental, lifestyle and dietary factors, which can lead to: (1, 2 3, 4 )
- impaired skin barrier function;
- changes to intestinal barrier function; and/or
- a dysregulated immune system.
People with atopic eczema often have:
- a “hyperactive” immune system (usually shown by high levels of IgE antibodies in the blood).
- a personal or parental history of allergies (e.g. to pollen, dust, or certain foods).3
- different bacteria in their gut compared to people without atopic eczema.1
There is no cure. Management is usually under the care of a GP or dermatologist and includes topical corticosteroids and emollients. New research is exploring whether targeted nutrition, alongside standard treatments, can improve outcomes.
How can nutrition help?
Everything you eat is broken down into nutrient “building blocks” which are then incorporated into every cell of the body. Vitamins and minerals are also needed for enzymatic processes that allow the body to function. The type of food that someone eats (and the fibre content) affects the type of bacteria in their gut. For these reasons, nutritious food choices can reduce symptoms and flare-ups of atopic eczema in the following ways:
- Improving and regulating the immune response.
- Maintaining and improving skin barrier function.
- Controlling inflammation in the gut and throughout the body.
- Altering the gut microbiome in ways that affect all of the above.
Top 7 nutrition tips for managing atopic eczema in ADULTS
1. Check vitamin D levels (2,4)
Vitamin D is often low in people with atopic eczema, and vitamin D plays an important role in the immune system, skin barrier function, and reducing inflammation. Request a blood test to check someone’s vitamin D level. If it’s low, the level will dictate what level of supplementation is required to correct it. The target level for serum vitamin D is over 50nmol/L.
Zinc is often low in people with atopic eczema, and zinc supports immune health, skin repair, and inflammation control. That’s why it is important to check the zinc levels in someone’s blood. There is no universal target level for zinc in people with atopic eczema, so use the reference range provided by the lab. Zinc supplementation should only be considered if a deficiency is confirmed on testing.
3. Increase omega-3 fats & gamma-linolenic acid (2, 6, 7, 8)
Omega-3 fats and gamma-linolenic acid (GLA) are beneficial fats that are incorporated into the membranes of most cells in the body – including skin cells, immune cells, and gut epithelial cells. Having these fats incorporated into the cell wall can help control inflammation, regulate the immune system, and improve skin barrier function.
Omega-3 fats are essential for everyone because the body cannot produce them, so they must be obtained from food or supplements. Food sources of omega-3 fat, such as oily fish, walnuts, and linseed, offer many benefits to nutrition and health. Unfortunately, most people don’t eat enough of these foods consistently enough and/or their body has difficulty converting plant-based omega-3 into its active forms, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Therefore, supplements are often the preferred choice to make sure people are getting enough.
Similarly, while the body can normally convert vegetable oils into GLA, research suggests that people with atopic eczema may struggle with this conversion process. Supplementation with GLA (in addition to omega-3 above) is therefore thought to help reduce skin inflammation.
Omega-3 and GLA work together, so it’s important to take both. While the exact dose (and ratio) of these supplements has yet to be determined, one study found that a supplement containing ALL of the following was helpful in reducing symptoms of atopic eczema after 16 weeks:
- 120mg gamma linolenic acid (GLA)
- 475mg linoleic acid (LA)
- 200mg alpha linolenic acid (ALA)
- 375mg eicosapentaenoic acid (EPA)
- 300mg docosahexaenoic acid (DHA)
- Plus vitamin C, vitamin E, and zinc
4. Eat more plant-based foods and fewer animal foods (3, 9)
A plant-based diet, high in vegetables, fruit, whole grains, legumes, nuts, and seeds can reduce overall inflammation in the body and improve the gut microbiome. Conversely, a diet high in processed foods and animal protein (such as meat, seafood, eggs and milk), tends to be higher in saturated fat and lower in fibre, which can increase inflammation and increase the risk of atopic eczema. Fortunately, just by adding more plant-based proteins to the diet (such as legumes, grains, nuts, and soy), the negative impact of animal protein can be reduced significantly.
5. Increase dietary fibre (6)
A high-fibre diet, containing at least 14 grams of fibre per day from legumes, whole grains, nuts, fruit, and vegetables, can reduce the risk of atopic eczema and partially offset the impact of eating high amounts of saturated fat and animal protein. This is mainly because of how dietary fibre positively affects the gut microbiome and reduces inflammation. The effect of dietary fibre is boosted if taken concurrently with a mixed probiotic supplement.
6. Consider probiotic supplements (4, 10, 11)
Probiotics enhance the barrier function of intestinal cells, thereby regulating both the immune system and the body’s allergic responses.
The research is still conflicting in this area, because studies have often used different strains, doses, and concentrations of probiotics, with and without prebiotics. However, newer research suggests that MIXED STRAINS of probiotics containing the following, can have a modest effect in helping adults with atopic eczema:
- Lactobacillus acidophilus
- Ligilactobacillus salivarius
- Lacticaseibacillus casei
- Lactiplantibacillus plantarum
- Bifidobacterium breve
- Bifidobacterium lactis
- Bifidobacterium longum
Exact doses have yet to be determined, but probiotic supplements should contain a minimum of 1 x 109 CFU (living cells) per dose. Most studies recommend a minimum of 8 weeks on these supplements to see an effect.
7. Don’t cut out any food groups (12)
Only eliminate foods (e.g. dairy, eggs) if an allergy diagnosis has been confirmed by testing. A comprehensive allergy assessment is therefore needed so that a consultant can review someone’s symptoms, blood and/or skin prick tests. If someone doesn’t have a diagnosed food allergy, then avoiding entire food groups just increases their risk of vitamin and mineral deficiencies, which can actually make symptoms worse.
Diet alone will not cure atopic eczema, but combining medical treatment with targeted nutrition may help reduce symptoms and flare-ups. As with most areas of health and nutrition, people see the greatest benefit when they address multiple factors at once. A dietitian can keep abreast of the current research and make bespoke recommendations based on someone’s current diet, lifestyle, blood test results, and clinical presentation.
To refer a case management or litigation client for a comprehensive nutrition and health assessment, blood tests, and dietetic recommendations, please contact Specialist Nutrition Rehab at 0121 384 7087 or info@specialistnutritionrehab.co.uk.