Up to 20% of children, and 4% of adults suffer with eczema. The amount of people with eczema has greatly increased over the last 30 years, so what`s going on?
Atopic dermatitis is the medical name for eczema. Eczema isn`t one specific type of skin disorder, it is an umbrella term given to a group of related skin conditions. Anyone who has a loved one in their family with eczema, or has it themselves is all too familiar with how painful this condition is, both physically and mentally. Eczema affects everything. Sufferers struggle to eat if the eczema is around their mouths, sleep and move about like non-eczema individuals. It can be hugely debilitating and exhausting.
Eczema causes itchy, dry and red inflammatory patches on the skin, which often develop into crusts and scales. They can crack open and be extremely sore. Some people get a few patches across their body, whilst other sufferers get covered in it from head to toe.
Not only is the condition so very painful, but mentally, our skin is what we present to the world, so sufferers can experience huge confidence issues and anxiety.
Eczema develops because of inflammation. Somewhere within the body, there is inflammation that is making it`s way to the skin. The inflammation on the skin then causes the eruptions that are all too familiar with sufferers. Eczema is also a hyper -elevated immune response. The sufferers skin is trying to protect them, but somewhere along the line it has become a little confused and over -reacts.
Whilst doctors tend to prescribe steroid creams and barrier creams to treat the skin itself, the actual cause of the inflammation in the first place is often ignored and so the cycle perpetuates over (what can be) years and years.
Naturopathic view of eczema
Our skin is a reflection of the body`s internal environment. If something is showing up on your skin, something is not right internally.
Naturopathically, we know that all waste and toxins that the body acquires or creates, has to leave efficiently. This is done primarily through the bowel and the kidneys as stools and urine. There are also other major elimination routes though; the lungs (our breath contains waste products), our menstrual cycle (our blood that is excreted during menses contains waste) and most importantly in this respect, our skin.
Our skin is our largest eliminatory organ. Certain molecules of waste are excreted through the pores of our skin in our sweat and sebum. Whilst the bowel and kidneys are the major routes of elimination, if they are under-functioning then the body will rely next in the chain of command upon the skin. This means that if we have something going on with our gut or kidneys that is preventing waste from leaving effectively, our skin has more demands put upon it. Extra molecules of waste that would not normally head out through the gut is sent to the pores for excretion. This extra demand causes a large amount of inflammation.
Equally, if we are regularly eating foods that we are intolerant to, or even have an allergy to, then we experience what is known as an immune reaction. Our bodies don`t want the proteins that we are intolerant to inside of us, and so our immune system launches an attack upon them. Our immune system only wants what is best for us, but in it`s efforts to protect us, some of the substances that it releases are hugely inflammatory and will irritate the skin.
Our livers are amazing. Quite frankly, the more I read about the liver, the more I am in absolute awe of it. Every minute of the day it is working tirelessly to change harmful substances that we encounter (and some that our own bodies make just by functioning) into less harmful versions in order to protect us. The liver is also in charge of converting sugars into a stored version that it keeps within itself. It makes bile and has many other functions. Everything we eat gets broken down into smaller molecules in our gut and absorbed into the blood stream. The blood heads straight to the liver in order for the liver to go about its sorting and conversion role.
If our liver is sluggish - something that can easily happen if we consume too much sugar, or high glycaemic index foods that put pressure upon the liver, then it is not as efficient at its job.
When this happens, we often get skin conditions as the liver just can`t keep up with the demands of what is being put upon it. The waste that is backing up will get reabsorbed into the blood and dumped in different places of weakness in the body. More often than not, this affects the skin. The sluggish liver is often at such a sub-clinical level that it would appear to be in normal range on any blood tests taken by your doctor and doesn`t mean that your liver is damaged. Livers are amazing and can rebuild themselves constantly, but in order to let it do this, we need to give it a rest from sugars, fructose, bad fats and chemical laden foods and products.
Why do I get eczema?
Every person on the earth is an individual and we all have our areas of weakness. Some people are prone to migraines, some to digestive troubles, some to aching muscles and joints (the list goes on...) and some - skin issues.
We are born into this world with certain predispositions, affected by our genetic makeup and our family lineage. We are even affected by how our parents lived whilst we were in the womb.
It is simply the case that if you suffer from eczema, this is currently your area of weakness. What is important is that we try to prevent flare ups and that we strengthen this area that you are more vulnerable in.
Some people have a genetic mutation in one of their genes that is responsible for the production of a protein called filaggrin. This protein normally helps to maintain the health of the stratum corneum layer of the skin, the primary barrier between the body and the environment.
Another genetic reason is that some people produce less serum, which a type of natural oil in the skin. If this is the case, their skin is very dry. Some people`s eczema is triggered because their immune system is on the low side, whilst other people are triggered due to an allergic response to certain foods or chemicals... more on this later.
One of the first things I do with a case of eczema is find out exactly what is going on in the gut. This requires a stool sample being analysed by a laboratory. If there are any pathogenic bacterias that have overpopulated the gut then sure enough, you will see skin conditions flare up. Likewise, if the gut microbiome doesn`t have enough beneficial bacteria, it will show up on your skin.
Anyone presenting to me with eczema would be encouraged to complete a pinprick food intolerance test that measures the immune response to certain foods. This is called an IgG intolerance test and is the only reliable method to determine sensitivities to foods. Common foods that trigger eczema are eggs, dairy, gluten, yeast and potatoes. If you test positive to this test, it does not mean you are allergic, which is quite different and can be life threatening. It means you have an intolerance, where your body mounts an immune response and causes great inflammation. These tests are not cheap, but they save the hassle of elimination diets, which can take several weeks/ months to get to the bottom of which foods bother you. Please don`t get tricked by some of the strange tests touted on social media regarding intolerance testing. The only accurate response is an IgG blood test.
Regardless of what your intolerance test reveals, you should remove gluten from your diet straight away. Gluten is a substance that nutritionists loath. It is inflammatory for almost everyone, even if they aren`t aware of it.
Many people get severe reactions to gluten such as bloating and abdominal discomfort, however gluten is sneaky. It can cause mood disturbances several days after eating it, so you wouldn`t suspect it. It can cause fatigue, aching joints and muscles, constipation and skin complaints. Ever had those annoying bumps on the back of your arms or thighs? try taking out gluten and see if they go away! (this can also be caused by dairy)
Gluten is an extremely reactive protein that slows the profusion of blood to the brain. Because of this it can have all sorts of effects on our mood. It can cause depression, anxiety and even hyperactivity in children. We know that eczema is worsened by anxiety and emotional upset, so it is essential to support our mood in as many ways as possible.
Gluten inhibits the liver. This means that the liver is slowed down in its processing and it is more likely that toxins and waste will back up and get reabsorbed. Remember from the paragraph about the liver - this means they will show up on the skin.
Gluten inhibits thyroid function. Our thyroid is a master gland that controls metabolism and the functioning of just about everything. Regarding the skin - if the thyroid is slower then our skin gets dry and thick.
Gluten is indigestible. It hinders the digestive process. Think of pizza dough - gluten is sticky and stretchy and adheres to the gut wall, getting in the way of the nutrients in food being able to be absorbed. Eating gluten regularly causes our ability to absorb our nutrients to be inhibited. If we aren`t getting enough zinc and other essential skin nutrients we will get problems on its exterior surface.
The gluten proteins that adhere to the walls of the gut also prevents waste products from working their way out of the bowel efficiently. This causes them to get reabsorbed back into the blood and taken back to the liver again, implicating the liver. This will show up as inflammation where your area of weakness is, in this case - your skin.
Sugars and refined carbohydrates
Remember that your gut has to be in good working order to get those waste products out. It relies on your microbiome to be healthy and full of beneficial bacteria to do this. Diets that contain sugars and refined carbohydrates (those starchy white carbohydrates made of white flours) have a negative impact upon our beneficial bacteria. Our beneficial bacteria are like bouncers on a nightclub door. They stick together to keep the trouble makers out. Unfortunately, there are other types of bacteria called pathogenic bacteria that like to take up residence in our guts. If they take hold, then our body is in for trouble.
Unfortunately, the trouble making bacteria love sugar. Glucose is their main source of food. Not only does it strengthen the bad guys, but it encourages them to multiply and before you know it, our bouncers are outnumbered and the trouble makers have taken over the nightclub!
Unfortunately, whilst the pathogenic bacteria thrive in these conditions, our beneficial bacteria (the bouncers) weaken and die off. Our microbiome is left with very little defenses and the whole environment is a negative one. We are left with a gut that is high in toxicity and can not eliminate it as well through its normal route of the bowel. The toxins will get reabsorbed by the blood and sure enough, this will show up on your skin.
It is essential when you are trying to recover from eczema that you eliminate sugars and follow a low G.I (glycaemic index) diet. The glycaemic index is a way of charting food as to how much glucose it converts to (the food that the bad bacteria love). You can read more about the glycaemic index here.
Sugar is also an anti-nutrient. That means that it has no beneficial nutrients for the body and takes more nutrients to digest and eliminate it than it gives. It leaves the body with a nutrient debt. As an eczema sufferer, you need to get as many nutrients from your food as possible, not give them away to digest a meaningless molecule.
Sugar, is one of the most dehydrating causes of the body. Consuming sugar and high glycaemic foods causes the cells of the body to lose water, along with magnesium and potassium. Instead, the cell is replaced with sodium and calcium and becomes acidic. The polarity of the cell changes from a negative charge to a positive charge. All this means that the cell is weak, vulnerable and in a perfect state for disease. You can read more about this process here. One thing for sure is that when you have a skin condition, your cells need all the help that you can give them, so removing sugar and high glucose foods is so important.
Every cell has a layer around it made of essential fats. This phospholipid layer needs replacing to keep the cells healthy. Anyone who comes to a naturopath with skin conditions will be quizzed about the amount of essential fats that are in the diet.
Essential fats are the omega fats. Omega 3, 6 and 9 are all essential for the health of the body. Omega 6 is quite easy to get from food, but omega 3 is less abundant. Unless you are eating oily fish at least twice a week and regularly eating nuts and seeds, the chances are that you aren`t getting enough essential fats in your diet.
If the fatty layer of the cell is not constantly replaced, it goes rigid and hardens. If this happens, the cell can`t get its waste products out into the bloodstream for elimination, they will fester inside the cell instead. Likewise, the blood can`t get the essential nutrients into the cells for them to be healthy, so the cell is under nourished and toxic. Take a look at this diagram that explains it further.
Vegetarians and vegans can struggle with essential fats as whilst nuts and seeds are good, they don`t contain the same amounts of fat and huge quantities would have to be eaten to gain the right amount.
Most people would benefit from supplementing with essential fats, but it is important to get the balance right. Vegetarians and vegans can also benefit from vegan friendly omega 3 , which is made from algae.
If you suffer from eczema or dry skin conditions , it is essential to take a look at your essential fats.
Remember that sufferers of eczema have inflammation.
It is important to lessen the inflammation in the body to support eczema. An anti-inflammatory diet is a way of eating that limits anything that the body doesn`t recognise in its natural form. If food contains chemicals such as preservatives, flavourings, colourings, stabalisers etc, they cause inflammation deep within the body, that isn`t always noticeable. This inflammation shows up elsewhere and in the case of eczema, can trigger skin problems. anti-inflammatory diets keep as close to nature as possible. Packaged and processed foods are off limits. You can learn more about anti-inflammatory diets here - Anti - inflammatory diet
Most people are chronically dehydrated. An adult should drink 1.5 - 2 litres of water per day and more in hot weather or if they are exercising. Dehydration, (as mentioned earlier when I was talking about sugar), is really bad for our cells. The electrolyte balance is changed and the cell is put into a disease promoting state. Remember, every serious disease starts with just one cell changing in a way that it shouldn`t. It is vital to look after our cells. Hydration is key to healthy skin. Gradually eliminating caffeine and alcohol is something that everyone would benefit from, but is especially relevant if you suffer with skin issues. Aim to start the day with some lemon water and keep hydrated throughout the day.
It is so important to get vital nutrients to heal the skin. A diet rich in antioxidants vitamins and minerals is key to supporting the skin. (Anti-oxidants help the body by deactivating free radicals that would otherwise cause oxidative damage to cells).
Your diet should be largely soluble fibre based. By soluble fibre I mean fruits and veggies. You can read more about this here. Aim for 60% of your meal being vegetable content at least twice per day and try to include as many different coloured vegetables as possible.
Zinc is a key nutrient for skin health. It is found in shellfish and organ meats especially but is also in meat. If you are vegetarian or vegan then it is harder to increase your zinc levels. Whilst it can be found in pumpkin seeds and some other vegetarian foods, it is in much smaller quantities. If you are vegetarian or vegan you should make sure that your multi-nutrient contains zinc or talk to me about supplementing with zinc. Ginger contains some zinc, try drinking grated ginger and a squeeze of lemon in warm water. This will not only help your zinc levels but will also help support your liver and your hydration.
If you visit your GP with eczema, the conventional treatment is to use steroid creams. Unfortunately, this does nothing for getting to the root cause of your skin flare ups and won`t prevent them from coming back in the future. Steroids are sometimes necessary, to prevent the itch- scratch cycle from continuing and in the short term are not dangerous. Their continued use is not advisable, in fact they shouldn`t be used for more than 2 weeks at a time.
Extended use of steroid creams will actually do the skin more harm than good. it can atrophy and become very thin. Other notable adverse reactions include acne, excessive hair growth, dryness and the risk of infection. Like your gut, your skin has a bacterial microbiome. A colony of good bacteria that help keep the bad ones (like Staph) at bay. Every time you use steroid creams, you are stripping off your good bacteria. They are no longer there to protect the skin environment.
When using steroids, you are simply suppressing the root cause of the problem, which will flare up in other parts of the body if it isn`t sorted out. Commonly, people can develop asthma if they have eczema. Whilst the skin problems are being suppressed, the inflammation will go elsewhere in the body. Remember earlier, when I said that the lungs are an elimination root? If your body can`t eliminate waste properly through the bowels or skin, the next port of call is usually the lungs.
The other problem with steroid use is that the skin becomes addicted to it. TSW (topical steroid withdrawal) and TSA (topical steroid addiction) are common problems associated with extended steroid use. The skin actually becomes reliant upon the steroid and when they are stopped, it can flare up in angry red patches. These red patches can then pop up in other areas where you have not previously had eczema. If you are trying to stop using topical steroids then you should seek advice from a naturopath and work together to lessen TSW.
If you had a piece of glass on your driveway that you kept driving over and puncturing your tyre, you wouldn`t just keep replacing your tyre, you would remove the glass, right? Think of your eczema as the piece of glass. If you just keep putting on creams, you are replacing your tyres. You need to find out what exactly is the obstacle to your skin`s health and remove it. Otherwise, you will keep going around in circles with your eczema.
There`s lots to be done to support your eczema from the inside - out. It isn`t a guick fix though.
Your health is like a pickled onion - it has lots of layers that need peeling away. Supporting your eczema can take 3 - 6 months and sometimes longer, but it will be a journey that you will be so glad that you traveled. It may mean changing your diet and lifestyle, but you`ve got to think - what is more important to you? A piece of bread? Or skin that is healthy and doing what it is supposed to do... protecting you from the outside environment and showing who you are to the world.
Thrive Clinical Nutrition and Naturopathic Health Eve Morley N.T AMNNA FNTP NFPTA