Elimination Diet For Skin Conditions
Overview
Your skin deserves better. There is something that you do every day that can create problems for your skin. To you, your skin problem may be called psoriasis, eczema, rosacea or other rashes, but to your skin it is an allergic reaction, and the source of that reaction is very likely foods that you are putting in your mouth.
There is general agreement, even in the medical community, that many common skin diseases can be made worse (or are the result of) the foods that we eat. The problem has long been how to decide - out of all the different foods you eat - which ones are causing the skin eruptions.
An elimination diet is your best choice for uncovering food allergies and intolerances that may be the source of your skin condition.
The difference between allergies and intolerances
Food reactions can be classified as either a food allergy or a food intolerance. While food allergies are well accepted in medical circles, food intolerances are not. Finding a way to discover both your food allergies and your food intolerances may be the key to clearing up your skin condition.
Food allergy. The first type of food reaction is a food allergy. In a food allergy, your body considers a particular allergenic food you are eating to be a foreign substance, and the immune system mounts an attack against that allergen.
Most of these allergies are due a component of the body's immune system called immunoglobulin, and specifically the "E" type of immunoglobulin, or IgE. The most extreme form of this type of food allergy is an anaphylactic reaction (usually to something like peanut butter or shellfish). These reactions can produce hives, difficulty breathing, and even shock.
Another type of food allergy occurs that is less dramatic than an IgE reaction, and slower to develop. These reactions can produce sneezing, headaches, and drippy nose, and are caused by another immunoglobulin, called IgG.
The most common food allergies are to egg, seafood, milk, shellfish, soy, wheat, tree nuts and peanuts.
Food intolerances. Food intolerances are different from food allergies in that the immune system generally does not play a central role in these types of reactions. While food allergies are well recognized in the medical community, not so with food intolerances. Jonathan Brostoff and Linda Gamlin, authors of a book on food allergies and intolerances, have this to say about food intolerances:
Food allergies… [are] a recognized complaint whose underlying mechanism is fairly well understood. Food intolerance, on the other hand, is not regarded as a sound diagnosis by the majority of doctors. Most would agree that there is such a thing as food intolerance, but they would argue that it affects relatively few people.
The classic food intolerance is lactose intolerance, where the body lacks the enzyme lactase to digest the sugar found in dairy products, but many food intolerances are the result of more than just lacking an enzyme.
Food intolerances can be broken down into three categories:
- Metabolic. These types of intolerances are generally due to the inability of the body to metabolically process the food that you are eating. Typically, this means that a key enzyme is missing and the food doesn't get digested or used properly in the body. Once again, lactose intolerance is the most common of this type of intolerance.
- Pharmacological. This type of reaction is the result of either natural compounds present in the foods (such as amines, salicylates, glutamates) or to preservatives, emulsifiers, colorings, and other food additives. These compounds can create a reaction similar to a drug side effect in people who are sensitive to these chemicals.
- Toxic. A toxic reaction may be due to various forms of contamination of food, including toxins found in herbicides, fungicides, and pesticides; bacteria (or some other organism) contaminating the food; or even the result of toxins produced by bacteria in your gut.
From the point of view of your body and your skin, it doesn't really matter if you have a food allergy or a food intolerance - the end result is the same: skin eruptions.
A number of other symptoms besides skin conditions can tip you off to the possibility that you're dealing with a food allergy or intolerance. These include headaches, acne, asthma, diarrhea, joint pain, sinus congestion, fatigue, and even depression and anxiety.
Many paths to uncover allergies
Uncovering which foods you are allergic to can be difficult. Medical techniques for determining food allergies do exist and fall into two general categories: challenge and immunological testing.
Challenge test. In a challenge test, a small portion of the suspected allergen is tested by injecting or scratching into the skin:
- Skin prick test. Potential allergens are tested by scratching them into the skin. Usually the patient has to wait 24 hours to return, at which time the reaction is noted for size and severity.
- Intradermal test. This type of testing is similar to skin prick test, only the allergen is injected into the skin.
Immunological testing consists of drawing blood, exposing portions of the blood to allergens, and then measuring the body's reaction to those allergens. The three main types of immunological allergy testing are:
- ELISA: enzyme-linked immunosorbent assay
- RAST: radioallergosorbent
- ImmunoCAP: immunoassay capture test
While all these tests are somewhat effective for finding food allergies, they do nothing to help uncover food intolerances. If you are looking to discover the root of both food allergies and food intolerances, there is one way to go: an elimination diet.
Elimination diet
An elimination diet is a diet that removes all common food allergies and then slowly reintroduces those foods to the diet. This is the best way to uncover both food allergies and food intolerances.
The reason why an elimination diet works where the other testing doesn't is because it is testing the food exactly the way you are used to consuming it and is, therefore, using your body as the measure for what is good for it and what is not.
The other benefit of an elimination diet is that it helps to determine whether the symptoms you have are diet-related or if they are caused by another process. Typically, symptoms will start to improve within a few days of beginning on an elimination diet if food allergies or intolerances play a role. This is especially true for a skin condition such as eczema, or other rash-type eruptions; conditions such as psoriasis or rosacea may take a little longer.
How to follow an elimination diet
An elimination diet typically last for a few weeks and involves complete removal of a suspected food from your diet. It is best to spend at least 10 days without the food you are testing before reintroducing the food.
There are two types of elimination diets, the simple and the complex.
A simple elimination diet. This is probably the best place to start if you have never tried an elimination diet before. In this type of diet, you simply avoid one or more foods that you consider might be causing your problem. Typically, people have more than one allergy or sensitivity, so trying one food at a time may not work. The best approach for the simple elimination diet is to remove all common allergens at the same time. This means no egg, seafood, milk, shellfish, soy, wheat, tree nuts, or peanuts for at least 10 days before reintroducing these foods.
More complex elimination diet. This type of diet is best used for people with severe food reactions, or for people who have many symptoms or a more serious form of a disease.
The complex elimination diet removes the following:
- Food additives: including monosodium glutamate (MSG), artificial sweeteners, preservatives, artificial flavors, and all artificial food colorings.
- Alcohol: including beer, wine, and hard alcohol, but also including things like vanilla extract, Angostura bitters, mouthwash, cough medicine, and even homeopathic medicines that contain alcohol.
- Citrus fruits: oranges, tangerines, grapefruit, limes, lemons, and other citrus fruits.
- Shellfish: including lobster, crab, mussels, clams, scallops, and other shellfish.
- Nuts: tree nuts, including cashews, pecans, walnuts, pistachios and other tree nuts; as well as groundnuts (peanuts).
- Corn: including corn oil, high-fructose corn syrup, vegetable oil, corn chips, popcorn, corn starch, and other corn-containing foods.
- Dairy: including milk, cheese, butter, cottage cheese, whey, yogurt, kefir, sour cream, and other dairy foods.
- Soy: in all its forms, including textured soy protein, tofu, tempeh, edamame, soy sauce, and soy milk.
- Eggs: both the yolk and the whites.
- Gluten: a protein found naturally in many grains, but also present through contamination in many other foods. Avoid pasta, flour, breads, cereals, cookies, and other foods made with gluten grains. Grains found to contain gluten include wheat, kamut, spelt, triticale, barley, rye, and oats.
- Sweeteners: honey, maple syrup, white sugar, fructose, dextrose, maltose.
Food cravings are another way to uncover a food allergy or intolerance. Strange as it may seem, we often crave foods we are allergic to. Search out your diet and remove any of the foods you feel especially drawn to for your elimination diet.
Foods that may be allowed include:
- Grains: Rice and millet, including rice cakes or crackers made from acceptable grains.
- Grain substitutes: Including amaranth and quinoa (often mistakenly categorized as grains).
- Fruits and vegetables: Most fruits and vegetables are generally okay except for citrus fruits and strawberries. Salad greens are generally okay. Some individuals have intolerance to solanaceous vegetables, which include tomatoes, tomatillos, potatoes, peppers, and eggplant - you may want to remove these.
- Beans/legumes: All are okay except for soybeans.
- Protein: Meats are generally okay.
Reintroduction of foods
The key to success with an elimination diet is in the reintroduction of foods. You spend 10 or more days away from your food allergies or intolerances, and when you reintroduce the foods, it becomes very clear whether they are a problem for you or not.
The best way to reintroduce a food is to test one food at a time, waiting to see if there are any reactions. A reaction can take the form of any sort of symptom, ranging from sinus drainage to excess gas, diarrhea, headaches, a return of a skin condition, or a more extreme allergic reaction. Typically, you choose the food you are most craving at the time for reintroduction, then eat a fairly large amount of it, waiting a day or two before trying the next food. Proceed this way through all foods that you have been avoiding until you have a group of foods to avoid and a group of foods that you can enjoy without having to worry about whether they bother you or not.
It is common to have to repeat this whole process a few times, as your food allergies and intolerances will change as you become healthier.
Challenging but worth it
An elimination diet can be quite challenging, as it is hard to avoid so many foods that we eat every day. The effort, though, is well worth the results. Uncovering food allergies and food intolerances leads to a healthier you and a general lessening - or complete removal - of many skin conditions.
How Can We Help?
At DermaHarmony, our goal is to help inform chronic skin care sufferers about their choices, if necessary improve choices, and then support you in any way we can. Our Program supports healthy skin with nutritional supplements, topical treatments and dietary guidance. To learn more about our programs, click here or call us toll-free at 1-800-827-3730. Our Support Desk is open 9:00 a.m. – 6:00 p.m. EST, Monday-Friday.
Our skin assessment is designed to help us get a better understanding of your symptoms and to make diet and lifestyle recommendations for you. It’s super easy and free and only takes about 5 minutes. Take our Skin Assessment.
References:
Resano, A., Crespo, E., & Fernández–Benítez, M. 1998. Atopic dermatitis and food allergy. J. Investig. Allergol. Clin. Immunol., 8 (5), 271-276.
Werfel, T. 2001. Skin manifestations in food allergy. Allergy, 56 (Suppl. 67), 98-101.
Brostoff, J., & Gamlin, L. 2000. Food Allergies and Food Intolerance: The Complete Guide to Their Identification and Treatment. Rochester, VT.
Principal Author: Scott Olson, ND
Date of Publication: 01/12/2009
Updated: 08/20/2009
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