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Allergies, Sensitivities, and an Anti-inflammatory
Diet for Optimal Skin Health


Tips from the Skin Dietitian
by Deirdre Earls, MBA, RD, LD

A report summarizing some 12,000 papers on food allergies in Wednesday's Journal of the American Medical Association was welcome news. The report, organized by the National Institute of Allergy and Infectious Diseases, finds the field rife with poorly done studies, misdiagnoses, and tests that can give misleading results. I say this was "welcome news" because it confirmed what I have observed over two decades as a registered dietitian and have discussed with patients for years. Just as perfect diets and perfect medications do not exist, neither does a perfect diagnostic tool when it comes to determining whether or not an allergy or intolerance exists.

It's clear that foods can elicit severe or even life-threatening inflammatory reactions and that antibodies are associated with an allergy. But wisely, Joshua Boyce, MD, chairman of the project and associate professor of medicine at Harvard Medical School, posits that a positive test for IgE antibodies to a food does not necessarily mean a person is allergic to that food. During development, he notes, the immune system tends to react to certain food proteins, producing IgE antibodies. But, Dr. Boyce explains, "these antibodies can be transient and even inconsequential. There are plenty of individuals with IgE antibodies to various foods who don't react to those foods at all. The higher the levels of IgE antibodies to a particular food, the greater the likelihood the person will react in an allergic way. But even then, the antibodies do not necessarily portend a severe reaction." Adding to the vagaries, "everyone has a different definition" of a food allergy, as Dr. Jennifer Schneider Chafen of Stanford's Center for Primary Care and Outcomes Research points out. Food intolerances are even less understood. All in all, whereas some 30% of the population thinks they have food allergies, the true incidence of food allergies is only about 8% for children and less than 5% for adults.

However, given that they've determined the 12,000 papers and the associated diagnostic tools and diagnosticians are unreliable, I find it hard to believe that these estimates are reliable, either.

[It's also notable that in this forest of admitted uncertainties, muscle testing didn't garner even a single mention.]

The good news is that virtually no one questions the potential value (and cost savings) of simply eliminating suspected foods from your diet and then observing changes. The tricky part here is how to pinpoint what is "suspected." Diagnostic tests can be a very useful window to see into an individual's response to a food, but in my experience they don't reveal the whole picture. The mindfulness of a patient or parent and their personal report of historic responses are indispensable.

Then it takes a highly skilled, appropriately credentialed practitioner who can review one's entire health history and look for other signs and symptoms over the course of one's life, make the potential connections to food(s), and then direct a proper anti-inflammatory elimination diet for a proper period of time. Many miss the point by focusing solely on which foods they think they should avoid.

But for those of us with chronic skin disease, the overall goal is to reduce the systemic inflammation associated with chronic skin diseases and their concomitant, potentially life threatening diseases. For psoriasis alone, these concomitant diseases include heart disease, diabetes, obesity, some forms of cancer and inflamed liver. Given the combined incidence of depression and psoriasis, I'd list depression as one of the potentially life-threatening diseases associated with psoriasis also.

From the standpoint of clinical outcomes, the most urgent need for any diet is that the person pursuing it be compliant and that the compliance be sustainable! Another stumbling block on the path to eliminating all suspected foods is the long list that can make enduring the diet seem worse than enduring the skin disease, therefore hastening termination of the experiment. Time after time I hear reports from those who tried a diet for a few weeks, or a few months, and when asked to quantify their compliance, reports were often 50% or less. More often than not they were convinced that their hit-and-run-while-running-on-empty diet had no impact on their condition.

Unfortunately, long-term success with skin disease and a proper anti-inflammatory diet often requires long-term compliance and long-term commitment. In the case of gluten sensitivity (which can be associated with 300 associated symptoms and disorders alone), it can take 2-5 years on a strict gluten-free diet for gut integrity to be recovered. For some, even 5 years on a strict gluten-free diet isn't sufficient.

Thankfully, in the case of chronic skin disease, just two proteins, gluten and casein, seem to be not only the most damaging but also the usual suspects. So even when a skin patient comes in with a long list of foods to which they have tested allergic (or nonallergic), I encourage them to start with a gluten-free and/or casein-free diet that offers overall anti-inflammatory benefits. It's true that foods like soy, egg, nuts, and shellfish are commonly reported as suspected food allergens and can elicit severe reactions. When a patient or parent of a patient tells me this, I encourage them to keep those items out of the diet. However, I can't recall a single patient report that elimination of soy, egg, nuts and/or shellfish was key to achieving remission of skin disease. I can't count the number of skin patients who have achieved some level of remission in skin disease—and probably improvements in other markers like blood pressure, weight, glucose, moods, and sleep patterns to name a few—after successful and sustained implementation of a gluten-free and/or casein-free anti-inflammatory diet.

Although initially it might seem overwhelming, Mother Nature puts the highest quality, gluten-free and/or casein-free anti-inflammatory diet at your fingertips, and she's got the best prices in town, too. Think of how your ancestors—and I mean ALL of them—were eating prior to ovens, stoves, refrigerators, freezers, preservatives, herbicides, grocery stores, the internet, and increasingly contaminated oceans. And in the USA where meat and dairy still garner a huge chunk of our USDA Food Pyramid, we can't forget the dietary impact of factory-farmed animals given supplemental hormones and antibiotics while fed genetically engineered grains created in laboratories. If you start with your great-grandparents and go back 100 years, and then go back every single generation in your entire history, you'll see that they were eating the same things for a very, very long time. Organic was the conventional form of farming for a very, very long time. The odds are very, very good that you are designed to eat the same things as your thousands or hundreds of thousands or more prior generations were eating.

If you don't eat as you're designed to eat, you can't really expect better results than when you put unleaded fuel into a diesel engine. Ponder how much bread, cereal, or cookies your ancestors were eating if they had to grow the grain, grind it, and then cook it over a fire, because ovens with controllable temperatures did not exist. How much meat (fish, chicken, beef, or pork) were they eating if there was no refrigerator or freezer to keep the leftovers in, after killing an entire cow? And how big were their portions when they had to contend with changing seasons, droughts or floods, not to mention all the work associated with securing just one portion of food?

People living today in Third World countries are still eating this way. And some of them, like those in Jordan, are living longer than we in America do—despite potentially never seeing a physician nor dentist once in their entire lives. Although we already spend far more per capita than any other country on the planet for health care, the United States now ranks 42nd in the world for longevity. Many believe a healthier diet will cost more. Remember that billions in Third World countries are eating rice, beans, and vegetables every day, in no small part because eating this way is a bargain, even before you estimate potentially huge savings in health care expenses.

What's the easiest, most effective and most affordable way to eat as you're designed to eat, while following a gluten-free and/or casein-free anti-inflammatory diet? Eat as your ancestors ate, meaning eat what you find growing or living whole in nature. To the degree that it's a whole food, there is no ingredient list and thus far fewer sources of confusion. The food is what it is, and you'll likely not be confused about whether or not gluten and casein lurk within.

To remove gluten, the primary grains you'll eliminate are wheat, barley, rye, triticale, semolina, spelt, and couscous, as well as oats, too, if not specifically certified as "gluten-free." In lieu of bread, pasta, and cereal, opt for true whole grains, meaning that the grain has not been ground. Brown rice, millet, and quinoa become staple fiber-rich complex carbohydrates. To eliminate casein, think of mammalian milk of all kinds and their obvious products like milk, butter, yogurts, and cheeses. This applies to all mammals, including goat, buffalo, and even humans.

Then, to the degree that you want to maximize the anti-inflammatory power of your diet, you'll also need to make your diet heavily plant-based. Every day should have you including more fruits and vegetables than any other category, ideally 10–15 portions per day. In addition to whole, gluten-free grains, also emphasize beans, lentils, nuts, and seeds as quality protein sources far more often than meat, dairy, or eggs. For more details, see Your Healing Diet, or check out the Healing Foods Pyramid developed by the University of Michigan's medical school and Integrative Medicine Department.

Applied common sense goes a long way toward understanding the basics of a healthy diet that simply resembles the way we humans have eaten for eons. Understanding how and why we react to some foods, how to eliminate or avoid foods we love, and how to apply a gluten-free and/or casein-free anti-inflammatory diet in the context of busy lifestyles, are far more complicated topics. But if I can do it, you can, too. Grant yourself the time, patience, and persistence to better understand how your diet impacts your total health. Take pride in baby steps if that's what you can muster, and just keep heading in that direction of progress. Even mistakes serve their purpose and when the time is right, you'll be ready to take the plunge to determine how a committed, extended dietary experiment may change your life—not just your skin.


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bookAllergies, Sensitivities, and an Anti-inflammatory Diet for Optimal Skin
Health—Reference Documents and Further Reading


Principal Author: Deirdre Earls, MBA, RD, LD with contributions from
C. Lucida, DermaHarmony Science Editor
Date of Publication: 05/25/2010
Updated: 04/14/2011