Eczema and diet - An update from a dietitian.
Article for the Eczema Association 2003
For over twenty five years I have been seeing improvements in eczema with dietary investigation. An interesting aspect is that the people whose diet I was investigating had usually not contacted me because of eczema. My main work has been to investigate the role of diet in ADHD - Attention Deficit Hyperactivity Disorder and ADD - Attention Deficit Disorder in children. The family would bring along a child with restless and impulsive behaviour, and poor concentration. Usually the symptoms would also include settling and sleep problems, being irritable, and "off with the fairies". Sometimes the child had eczema as well, or a brother or sister, or parent had eczema.
After the diet trial they would often report that as well as diet decreasing the behaviour, mood and sleep problems, the eczema had decreased. In fact, now when people ring to ask if diet has a role in their symptoms [and they may include any atopic symptoms such as hives, rashes, hay fever, sinus problems, as well as migraine, IBS - irritable bowel syndrome - and mouth ulcers], I, and other researchers, ask if eczema, migraine or IBS is or was present in the person or a close relative. The reason for this is if there are atopic symptoms like eczema present, then the likelihood that an additive free, low natural chemicals diet would be of benefit, is much higher. This important news needs to go out to families with eczema.
One reason that diet and eczema is not well understood it that there are three parts to what I call "Diet detective work". Often families with eczema consider the second part and much of the third part.
The first part is the exclusion of the suspect additives and natural chemicals, which include salicylates, amines and mono sodium glutamate. These should be seen as chemicals which "aggravate the underlying condition". Many people note that spicy food, citrus or high additive food make the eczema worse, but do not realise they can do more. However reactions to these suspect chemicals can be tricky as the symptoms only become worse when the total sum of several additives and natural chemicals add up to that person's tolerance threshold. The normal diet contains suspect foods such as apples, tomatoes, spice, as well as chocolate, and additive colour and flavour.
The second part of dietary investigation is minimisation or exclusion of whole foods to which the person is allergic. These are known when a reaction occurs to a food introduced in infancy, such as dairy foods, soy, wheat, or eggs, or from allergy tests preferably done with an allergist, immunologist or dermatologist. The other indicator of a whole food being suspect is if a close relative reacts, even if their symptoms are not eczema.
The third part of dietary investigation is to exclude non dietary suspect allergens and chemicals in the environment. The allergens, such as dust mite, pollen or dander, are also found from allergy testing. The chemicals to be minimised include all smells, perfumed products and plants, products with benzoate preservatives, and skin contact with coloured finger paint or playdough. Other environmental factors that aggravate symptoms include infections [as well as the additive flavour and colour in the paediatric syrups used to treat them], stress, insect bites, hormone changes, and, in babies, teething.
Many of these aggravators are known to eczema sufferers. Yet the diet component is often dismissed, as if it should be magic on its own, rather than be part of what I call the "Total Body Load" of suspect items.
Families with eczema know that it takes time to work out what medical treatment suits their own child. "Diet detective work" is the same. The trick is to reduce all the suspect items at the same time for a month and do challenges. This can take a little effort at first, but if symptoms are reduced then the additional effort required for treatment is minimised.
At some time in the life of each person with eczema it is wise to get the help of a dietitian familiar with dietary investigation, and/or use a book such as "Are you food sensitive?" to use the detail now available on the role of diet in their eczema.