Optimising a Vegan Diet for Managing Atopic Dermatitis

Atopic dermatitis (AD), commonly known as eczema, is a chronic inflammatory skin condition characterised by dry, itchy, and inflamed skin. Nutrition plays a crucial role in managing this condition, but when it comes to dietary choices, not all diets are created equal. The vegan diet, which excludes all animal products, has gained popularity for its ethical, environmental, and health benefits.

​However, while a vegan diet can provide a wealth of nutrients, it may pose certain challenges for those trying to manage atopic dermatitis, especially if they need to follow a low FODMAP diet or avoid common triggers like tomato and soy. This article will explore the potential pitfalls of a vegan diet for those with eczema and provide insights on how to optimise a vegan diet whilst managing atopic dermatitis.
 
Potential Nutrient Deficiencies
 
One of the main concerns with a vegan diet is the potential for nutrient deficiencies. Key nutrients that are often lacking in a vegan diet include:
 

• Vitamin B12: This vitamin is essential for skin health and immune function. A deficiency in B12 can lead to skin disorders, including dermatitis, as well as impaired immune response, which may exacerbate atopic dermatitis.
• Zinc: Zinc plays a critical role in skin barrier function and immune response. Low levels of zinc have been linked to poor skin healing, increased skin inflammation, and impaired immunity, all of which can worsen eczema symptoms.
• Omega-3 Fatty Acids: These essential fatty acids are known for their anti-inflammatory properties and are crucial for skin barrier integrity. Vegan diets often lack sufficient omega-3s (especially EPA and DHA) found in fish and seafood. While flaxseeds, chia seeds, and walnuts provide ALA, the conversion rate to EPA and DHA is limited.
• Vitamin D: Adequate vitamin D levels are essential for immune regulation and skin health. Vegan diets can be low in vitamin D, which is primarily found in animal-based foods, although some plant-based foods and fortified products do provide it.

 
Challenges for Those Following a Low FODMAP Vegan Diet
 
For individuals with atopic dermatitis who also need to follow a low FODMAP diet due to gut sensitivity or irritable bowel syndrome (IBS), managing a vegan diet can be even more challenging. The low FODMAP diet restricts certain types of fermentable carbohydrates that can cause gut distress, and many plant-based protein sources, such as beans, lentils, and certain vegetables, are high in FODMAPs.
 
This restriction limits the variety of plant-based foods that can be consumed, potentially leading to inadequate protein, fibre, and micronutrient intake. In addition, a lack of plant-based foods diversity can negatively impact the gut microbiome, which is increasingly recognised as a key factor in managing atopic dermatitis.
 
My Tip: Focus on low FODMAP plant-based proteins such as firm tofu (if soy is tolerated), tempeh, canned lentils (in limited quantities), quinoa, and small amounts of nuts and seeds. It may also be helpful to work with a Registered Nutritional Therapist to ensure adequate nutrition while following both a vegan and low FODMAP diet.
 
Avoiding Common Triggers Like Tomato and Soy
 
Tomato and soy are common triggers for some individuals with atopic dermatitis. Tomatoes are high in natural acids and certain compounds that can aggravate skin conditions in sensitive individuals. Soy, on the other hand, is a common allergen and can also be a high FODMAP food depending on the form consumed (e.g., soy milk from whole soybeans).
 
For vegans who need to avoid both tomatoes and soy, their diet can become extremely restrictive. Soy is a staple protein source in many vegan diets, and avoiding it requires careful planning to ensure adequate protein intake. Similarly, tomatoes are commonly used in sauces and plant-based dishes, making it necessary to find suitable substitutes.
 
My Tip: Opt for alternative protein sources like chickpeas (if tolerated), lentils, quinoa, hemp seeds, and pea protein. For cooking, use alternatives like coconut aminos instead of soy sauce and prepare tomato-free sauces using ingredients like roasted red peppers, carrots, or butternut squash. Coconut aminos can be found in some health food shops or on Amazon.
 
Overreliance on Processed Vegan Foods
 
The rise of veganism has led to an increase in the availability of vegan processed foods, which are often high in refined sugars, unhealthy fats, and additives. These processed foods can trigger or exacerbate inflammation, potentially worsening atopic dermatitis symptoms. Many processed vegan foods lack the necessary micronutrients that whole foods provide, leading to possible nutritional imbalances.
 
My Tip: Focus on a whole-food, plant-based diet rich in fruits, vegetables (low FODMAP if necessary), nuts, seeds, legumes (low FODMAP alternatives), and whole grains. Minimise the consumption of processed vegan options to support better skin health.
 
Imbalance in Omega-6 and Omega-3 Fatty Acids
 
A vegan diet, especially if heavily reliant on vegetable oils like sunflower, safflower, and corn oil, may lead to an imbalance between omega-6 and omega-3 fatty acids. Omega-6 fatty acids, while essential, can promote inflammation when consumed in excess, particularly when not balanced with anti-inflammatory omega-3s. This imbalance can contribute to a flare in inflammatory skin conditions such as atopic dermatitis.
 
My Tip: Incorporate more omega-3-rich plant foods, such as chia seeds, linseeds, hemp seeds, and algae-based supplements, to maintain a better balance of omega-6 to omega-3 fatty acids.
 
Gut Health Considerations
 
The health of the gut microbiome is increasingly recognised as a critical factor in managing atopic dermatitis. A vegan diet that lacks diversity can impact gut health negatively. Additionally, certain plant compounds, such as lectins and oxalates, can irritate the gut lining in sensitive individuals, potentially contributing to increased intestinal permeability ("leaky gut") and inflammation.
 
My Tip: Ensure a diverse intake of plant-based foods, including various fibre sources like fruits, vegetables (adjusting for FODMAPs if needed), legumes, and fermented foods (e.g., sauerkraut, kimchi, and miso), to support a healthy and diverse gut microbiome.
 
Personalised Nutrition: Not One Size Fits All
 
While a vegan diet can offer many health benefits, it is not necessarily suitable for everyone, especially those managing a chronic condition like atopic dermatitis. Nutritional therapy should be tailored to individual needs, considering specific deficiencies, intolerances, and sensitivities. For some, including small amounts of high-quality animal-based foods or supplements may be necessary to achieve optimal nutrient balance and skin health.
 
Tip: Work with a Registered Nutritional Therapist who specialises in skin health to create a personalised nutrition plan that addresses your unique needs and supports your skin condition.
 
Conclusion
 
A vegan diet can provide numerous health and planetary benefits, but it is essential to approach it with caution when managing atopic dermatitis, particularly if following a low FODMAP diet or avoiding common triggers like tomato and soy. 
 
Paying attention to nutrient intake, minimising processed foods, balancing fats, and supporting gut health are crucial steps in ensuring a vegan diet supports rather than hinders skin health. 
 
As always, personalised guidance from a qualified professional is key to navigating the complexities of nutrition and skin health effectively.
 
By understanding these potential pitfalls, those with atopic dermatitis can make more informed dietary choices that help manage their condition more effectively.