Atopic eczema or dermatitis (AD) often starts in infancy and the good news is that for most children it spontaneously resolves by the age of seven. However, AD doesn’t like to conform and so for some, AD remains until puberty, may return in later adulthood and for the very unlucky stays with them throughout their lives.
Unfortunately for some children, the early onset of AD also signals the start of the ‘atopic march’, with the appearance of hay fever and even asthma, either in tandem with the AD or in some cases instead of (1).
In addition, whilst more boys are diagnosed with allergies in childhood, in adulthood women are significantly more likely to be diagnosed with a food allergy and the menopause has been identified as a time when AD flares can either increase or disappear. (17,18).
So why do some people get AD?
Helping clients with AD is my vocation, as I have suffered from this condition since I was 6 months old. I am so interested in this topic that I have just completed a Master of Science with a dissertation entitled: ‘Examine how nutrition can be used as a complementary tool for the support of eczema/chronic atopic dermatitis (AD)' and I will share some of what I learnt below:
Multiple causes have been identified including skin barrier disruption, mutations in the filaggrin gene, gut microbiome (gut bacteria) imbalance, as well as immunological (allergy/intolerances) and environmental triggers, yet there is still no definition of what causes AD. This lack of definitive cause leads to dermatologists and allergy specialists telling their patients that eczema is uncurable and that it can only be modulated by use of corticosteroids and other topical creams and emollients (2,3).
There are, however, several areas of research that might shed more light.
You may have heard of leaky gut, but it could be that AD sufferers have leaky skin which may be caused by the mutation of a skin protein gene called filaggrin (FLG). Basically, FLG is used to seal the skin barrier and acts to both stop water loss and potential pathogens crossing into the bloodstream. What this means in practice is that whilst the water loss creates the dry, flaky and itchy skin so well-known to eczema sufferers, the ‘leaky skin’ could also be allowing environmental and even food allergens to cross, triggering an immune reaction and inflammation. Up to 48% of AD sufferers have been found to carry this mutated FLG gene (FLG-null-allele) which makes it a very exciting area of research. (4–6).
The FLG research has also been linked to another area of AD research, the ‘dual allergen exposure hypotheses’ (12) relating to inappropriate immune response. This area of research suggests that the FLG affected ‘leaky skin’ exposes the AD sufferer to food antigens via touch. The food particle enters the bloodstream via the skin and is quickly identified as a foreigner by the person’s immune system. This causes the body to go into high alert, triggering inflammation and labelling that food antigen as a future threat. A vicious cycle then ensues with the inflammation causing further damage to the skin barrier and leading to even more risk of exposure to food and environmental antigens.
Recent studies have found that this type of food antigen exposure can lead to subsequent ingested food sensitivities and intolerances and provides a potential explanation as to why so many AD sufferers know that they react to certain foods, despite negative allergy testing. (13).
Studies have shown that child AD sufferers are at higher risk of IgE mediated food allergies but also non-IgE Mediated (delayed) allergies (14). Diagnoses are made via either a blood draw to test for specific IgE antibodies or via Skin Prick Test (15). Other possible tests include the Atopy Patch Test, IgG testing and the Elimination Diet. In children caution must be applied to the Elimination Diet as it is thought that continuous consumption of a trigger food will result in it being better tolerated and that the removal of this food from the diet for a period may result in an increased risk of severe allergy or even anaphylaxis (16).
The gut microbiome has become a key research focus within the last decade, both in terms of health generally but also specifically in relation to AD. Intestinal hyperpermeability (leaky gut) and gut microbiome (bacteria) imbalance are linked to worsened immunity, higher rates of inflammation and risk of allergies and intolerances. AD patients have been identified as being at higher risk of both these (10,11).
Recently research has started to focus on the skin microbiome (bacterial population). This research has identified that individuals with atopic eczema suffer from skin microbiome dysbiosis (imbalance) with a skew to an overgrown population of staphylococcus epidermidis and staphylococcus aureus (7,8). My clinical experience has often found individual clients who demonstrate a link between both skin and gut dysbiosis (9) and this is an area I am passionate about.
As mentioned in the introduction, AD doesn’t like to conform. Whilst there are some common recommendations to all AD sufferers, no two nutrition recommendations are alike, just like no two people’s skin or gut microbiomes are alike. What may work for one, will not work for another.
Supporting clients with this condition involves the combining of many pieces of information with practitioner knowledge. Seeking out the individualised manner of eating that allows that person to eat the most varied diet possible, whilst being aware of those foods and environmental triggers that may cause a flare.
The main objective is to provide the empowerment that allows for each client to have a sense of control, whilst having the knowledge to face new challenges, in line with AD’s non-conformist tendencies.
Below are some of the key nutrients that research has found to be supportive for AD sufferers:
Whilst a deficiency in zinc status has been long thought to be linked to AD, studies using supplementation did not show any benefits (25,26).
1. Ring J, Zink A, Arents BWM, Seitz IA, Mensing U, Schielein MC, et al. Atopic eczema: burden of disease and individual suffering – results from a large EU study in adults. J Eur Acad Dermatology Venereol. 2019;33(7):1331–40.
2. Nutten S. Atopic dermatitis: Global epidemiology and risk factors. Ann Nutr Metab. 2015;66:8–16.
3. Lopez Carrera YI, Al Hammadi A, Huang YH, Llamado LJ, Mahgoub E, Tallman AM. Epidemiology, Diagnosis, and Treatment of Atopic Dermatitis in the Developing Countries of Asia, Africa, Latin America, and the Middle East: A Review. Dermatol Ther (Heidelb) [Internet]. 2019;9(4):685–705. Available from: https://doi.org/10.1007/s13555-019-00332-3
4. O’Regan GM, Sandilands A, McLean WHI, Irvine AD. Filaggrin in atopic dermatitis. J Allergy Clin Immunol. 2008;122(4):689–93.
5. Barbarot S, Aubert H. Physiopathologie de la dermatite atopique. Ann Dermatol Venereol. 2017;144:S14–20.
6. Bergqvist C, Ezzedine K. Vitamin D and the skin: what should a dermatologist know? G Ital di dermatologia e Venereol organo Uff Soc Ital di dermatologia e Sifilogr. 2019 Dec;154(6):669–80.
7. Szari S, Quinn JA. Supporting a Healthy Microbiome for the Primary Prevention of Eczema. Clin Rev Allergy Immunol. 2019;57(2):286–93.
8. Martinez KB, Leone V, Chang EB. Western diets, gut dysbiosis, and metabolic diseases: Are they linked? Gut Microbes [Internet]. 2017;8(2):130–42. Available from: http://dx.doi.org/10.1080/19490976.2016.1270811
9. Nakatsuji T, Gallo RL. The role of the skin microbiome in atopic dermatitis. Ann Allergy, Asthma Immunol [Internet]. 2019;122(3):263–9. Available from: https://doi.org/10.1016/j.anai.2018.12.003
10. Szari S, Quinn JA. Supporting a Healthy Microbiome for the Primary Prevention of Eczema. Clin Rev Allergy Immunol. 2019 Oct;57(2):286–93.
11. Rinninella E, Raoul P, Cintoni M, Franceschi F, Miggiano GAD, Gasbarrini A, et al. What is the healthy gut microbiota composition? A changing ecosystem across age, environment, diet, and diseases. Microorganisms. 2019;7(1).
12. Lack G. Epidemiologic risks for food allergy. J Allergy Clin Immunol. 2008;121(6):1331–6.
13. Tricon S, Willers S, Smit HA, Burney PG, Devereux G, Frew AJ, et al. Nutrition and allergic disease. Vol. 6, Clinical and Experimental Allergy Reviews. 2006. p. 117–88.
14. Abuabara K, Margolis DJ. Do children really outgrow their eczema, or is there more than one eczema? J Allergy Clin Immunol. 2013;132(5):1139–40.
15. Dhar S, Srinivas SM. Food allergy in atopic dermatitis. In: Indian Journal of Dermatology. 2016.
16. Finch J, Munhutu MN, Whitaker-Worth DL. Atopic dermatitis and nutrition. Clin Dermatol [Internet]. 2010;28(6):605–14. Available from: http://dx.doi.org/10.1016/j.clindermatol.2010.03.032
17. Chen W, Mempel M, Schober W, Behrendt H, Ring J. Gender difference, sex hormones, and immediate type hypersensitivity reactions. Allergy Eur J Allergy Clin Immunol. 2008;63(11):1418–27.
18. Pali-Schöll I, Jensen-Jarolim E. Gender aspects in food allergy. Curr Opin Allergy Clin Immunol [Internet]. 2019;19(3). Available from: https://journals.lww.com/co-allergy/Fulltext/2019/06000/Gender_aspects_in_food_allergy.12.aspx
19. Rusu E, Enache G, Cursaru R, Alexescu A, Radu R, Onila O, et al. Prebiotics and probiotics in atopic dermatitis. Exp Ther Med. 2019 Aug;18(2):926–31.
20. Kim MJ, Kim SN, Lee YW, Choe YB, Ahn KJ. Vitamin D status and efficacy of vitamin D supplementation in atopic dermatitis: A systematic review and meta-analysis. Nutrients. 2016;8(12):8–17.
21. Navarro-Triviño FJ, Arias-Santiago S, Gilaberte-Calzada Y. Vitamin D and the Skin: A Review for Dermatologists. Actas Dermosifiliogr. 2019 May;110(4):262–72.
22. Balić A, Vlašić D, Žužul K, Marinović B, Bukvić Mokos Z. Omega-3 Versus Omega-6 Polyunsaturated Fatty Acids in the Prevention and Treatment of Inflammatory Skin Diseases. Int J Mol Sci. 2020 Jan;21(3).
23. Williams HC, Chalmers J. Prevention of Atopic Dermatitis. Acta Derm Venereol. 2020 Jun;100(12):adv00166.
24. Thomsen BJ, Chow EY, Sapijaszko MJ. The Potential Uses of Omega-3 Fatty Acids in Dermatology: A Review. J Cutan Med Surg. 2020;24(5):481–94.
25. Gray NA, Dhana A, Stein DJ, Khumalo NP. Zinc and atopic dermatitis: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2019 Jun;33(6):1042–50.
26. Vaughn AR, Foolad N, Maarouf M, Tran KA, Shi VY. Micronutrients in Atopic Dermatitis: A Systematic Review. J Altern Complement Med. 2019 Jun;25(6):567–77.
More and more of us are interested in modifying our diet to better support our planet, but many of us are lost with how to support our aims without compromising our nutrition.
This is an area for which I have a particular interest. In February 2019 I published an article entitled Nutrition Recommendations in the Age of Climate Change within my professional association (bant.org.uk) newsletter. With more and more clients coming to see me to ask for help in this area I thought that it would be best to undertake some further training and to check whether my knowledge was still up to date to be able to support my clients best. Last week I attended the Sustainable Food Choices Nurturing Human Health and the Planet course run by @christinebailey for @ION which also featured the supremely knowledgeable @realfoodcampaign.
Combining this knowledge from both my own research and last week’s course here are my top tips !
“I want to eat more plant-based, but legumes give me terrible digestive issues”
Does this sound familiar?
One of the solutions proposed to help support the planet is to introduce more plant-based meals to our diet, and with vegan and vegetarian options becoming more easily available many of us are embracing this new way of eating with gusto. The trouble is, changing your diet radically and in a short period of time can result in a host of digestive issues, including bloating, indigestion, flatulence, and pain.
It is important to note here that any persistent digestive issues should be checked by your GP, but if you can link the digestive symptoms to your new diet then the answer may simply be that your gut and the good bacteria (microbiome) it houses isn’t primed to digest those foods.
We all have a variety of different bacteria in our gut and different bacteria like eating different things. If you’ve been traditionally a ‘meat and two veg’ type of eater, then your microbiome population will be geared towards those foods. If you have traditionally rarely eaten legumes and your fibre intake was low, the bacteria population that likes those things may be small and struggle with the sudden influx. There simply isn’t enough of those bacteria to process the new diet.
The secret is to gradually increase your plant-based foods rather than suddenly go all in. As you increase your intake of fibre and legumes such as chickpeas, lentils, beans and peas, the population of bacteria that loves those foods will grow and so you will be able to tolerate more. Unfortunately, one of the main signs that this population is expanding is flatulence, but if you go gradually, it should be a temporary and should subside as as your gut gets accustomed to its new diet.
There is less taboo around menopause and its precursor perimenopause, but they are still topics that are little spoken about.
The perimenopause can be one of the trickiest times for women to understand. One minute you’re young, full of energy to do all the things you want to do in your life and whilst there may be challenges and you might be time poor, life, if you look back on it, seemed pretty good.
Then all of a sudden, age catches up with you and you don’t feel like quite the same person that you used to. You start to get tired more easily, some days you are already exhausted, and you’ve only just got out of bed. The weight that you used to be able to lose easily, now just stays stubbornly in place, however many of your old weight-loss tricks you deploy. Your brain feels foggy, like you’re wading through treacle, but it couldn’t possibly be anything to do with the menopause, I mean, you are much too young!
You are considered to be menopausal when you haven’t had a single period for at least a year. However, the run up to this point, called the perimenopause, can last for years, even up to a decade! The perimenopause is a transition period which women typically experience in their 40s, although like with everything there are always exceptions to the rule with some experiencing it in their 30s and others not until their early 50s.
In the perimenopause, levels of oestrogen, one of the key female sex hormones starts to become slightly more erratic. You may find that your cycle becomes longer or shorter, your flow may change, becoming heavier or lighter, you may suffer from stronger premenstrual symptoms than you ever have before. You may also skip some periods to the extent where you think – aha, that’s me done then – only for them to come back with a vengeance.
Symptoms usually linked to the menopause can also appear during perimenopause. These include:
Fibroids are more common during perimenopause. Symptoms of fibroids are spotting between your periods, blood clots during your period and periods that are significantly shorter or longer. If you are experiencing any of these, please do consult your medical practitioner.
Thyroid dysfunction. If you are struggling with your energy levels, then it is always worth going to the doctor and getting your levels checked. Thyroid symptoms can mimic menopausal symptoms and the ovaries, uterus, adrenal glands and brain all need good levels of thyroid hormones to function correctly.
Having stable blood sugar levels is a key part of managing menopausal and perimenopausal symptoms. Here are my top tips:
Sometimes we all need a little sugar reset. The more sugar you eat, the more it takes the next time to have the same effect. I’ve published my popular and absolutely free mini-programme, A Week to Reduce Your Sugar Cravings on my website so that it can be accessed at any time.
Phyto- oestrogens – What Are They and Why do you Need Them?
When it comes to diet, food is so much more than macronutrients like protein, carbohydrate and fat. We all know that vitamins and minerals are an important part of the foods we eat, but what do you know about phytoestrogens?
These are naturally occurring plant-based chemicals, which are structurally similar to oestrogen and which exert a weak oestrogenic effect. They are particularly helpful for women as they are adaptogens. This means that they can either replicate or counteract the effects of oestrogen and they are particularly useful if you are going through the perimenopause, have endometriosis, fibroids or premenstrual syndrome.
So how can phytoestrogens help?
There are three types of phytoestrogens: isoflavones, lignans and coumestans.
This month's free 30-minute online conference is on the theme of the Menopause and Perimenopause or pre-menopause.
Sign-up via this link https://p.bttr.to/3uvjtM5 to get some useful tips on which foods to include or avoid during this natural life chapter.
There will also be an opportunity to ask questions at the end.
Is your Metabolism out of Whack?
Hearing the term ‘metabolic dysregulation’ might leave you scratching your head in confusion. What’s that and what does it have to do with me? I can hear you say.
Do any of the following sound or feel familiar?
If our metabolism is struggling due to the nutrition it is receiving or our lifestyle factors, it can set off a chain-reaction of health issues, starting with the seemingly innocuous muffin top, through to high cholesterol, a creeping blood pressure and blood sugar imbalances.
Most people relate metabolism to weight loss or gain. I’ve often heard clients say that they have a ‘slow metabolism’ because they are finding weight loss slower than they hoped, but it is more intricate than that. Metabolism is literally at the source of every process in our body. Our metabolism isn’t a single thing, it is a myriad of process that breaks down nutrients from food and turns them into energy and components which help support all of the body’s cells, organs and systems.
It is, therefore, a lot more than an issue of weight gain and weight loss. Although being at a healthy weight is a key part of maintaining a healthy metabolism.
BMI (Body Mass Index)
What is a healthy weight? Well, that depends on a number of factors. Your height and weight for a start, how athletic and muscular you are and what life stage you are at. You’ve probably heard of BMI – body mass index – which most health professionals use as a basis for measuring a healthy weight parameter. The formula for calculating BMI (metric) is BMI= Kg/M2 but there are dozens of BMI calculators available on the net or in the app store which allow you to check it easily.
A normal BMI is considered to be between 18.5 and 24.9.
Overweight is between 25 and 29.9.
Obesity is classed if a BMI is over 30.
Please note, however, that if you are very sporty and muscular you might have a high BMI whilst actually being very metabolically healthy, so it is always worth checking with a health or nutrition practitioner before making any changes to your eating and lifestyle habits.
Body Composition Analysis
There’s a lot more to metabolic health than just your BMI or waist to hip ratio. A body composition analysis which can be done with a nutrition practitioner, at the gym or even at home with some basic body composition scales, although beware of the accuracy!
A body composition breakdown gives you additional information including fat versus muscle mass, where the fat is in the body, how much visceral fat you have (visceral fat is the fat that is located near your organs and that can cause the most damage, health wise), water percentage and bone mass. All of this information can provide a much clearer overview of your health.
How can diet and lifestyle help?
If you go back to the notion that your metabolism, which is at the basis of all of the processes in your body, is dependent on the food you eat, then it becomes clear how your nutrition can have an impact on your metabolism and health. Lifestyle factors such as sedentarism (sitting too much) and poor sleep have also been shown to have long lasting impacts on a person’s metabolism, we will cover this in a later blog.
It is important to remember, however, that there is no one-size-fits-all solution. The reason that there are so many different diet clans out there proclaiming that their way of eating is the solution to all, is because all of those ways of eating do suit some people, just not absolutely everyone.
I trained in Nutritional Therapy exactly because I don’t believe that we can all follow the same thing and get the same results. Over and over again in clinical practice this fact is confirmed. Each person needs to find the best way to nourish themselves that suits them best metabolically and which is sustainable for them long term.
Foods to Minimise
The science is stacking up against foods that are produced from ingredients extracted or refined from whole foods or Ultra-Processed Foods and Drinks (UPFD). These types of foods and drinks are all around us. Baked goods such as biscuits and cakes make up the largest group in the UPFD category and we all know how easy it is to reach for a chocolate hobnob with our cup of tea.
Fizzy drinks account for the lion share of the UPFD drinks market, how often do you add a can of something to your meal deal?
Lots of studies have been published over the last decade showing again and again the link between regular consumption of UPFDs and poor health outcomes. These range from cancer to cardiovascular disease, respiratory disease and diabetes.
Top Tips for Eating to Support Metabolic Health
If you would like some help in reviewing your diet please do get in touch for a free, no obligation discovery call, you can book in via my website: www.jessicafonteneaunutrition.com.
Even before the global pandemic that is putting such a strain on everyone's mental health, depression and anxiety were the most common mental health conditions worldwide and that's not even counting those people who suffer from low moods and anxiety, but who don't consult a doctor about it.
Food and drink today, particularly of the ultra-processed variety, has been positioned as a reward by the food industry and this has led to people turning to what they perceive as 'comfort foods' when they are feeling down, or are stressed. The trouble is, with modern society the way it is, humans now spend more time feeling down and stressed than ever before. COVID-19 is simply magnifying this already existing sense of malaise.
Over the past decade, the research community has taken more interest in the link between what we eat and how we feel. The comfort foods that people tend to turn to are high in carbohydrate and sugars which have an immediate effect on our blood sugar levels, sending them soaring. The trouble is, what goes up, must come down and the subsequent significant drop in blood sugar levels, result in another mood and energy crash, which leads to another attempt to raise levels by eating more carbohydrate/sugar rich foods. The mood rollercoaster.
Did you know that diets high in refined carbohydrates and sugar are also inflammatory? Long term or chronic inflammation has been found to link back to a higher risk of depression and this might link to potential damage to our microbiome..
Our microbiome - or bacteria population in our large intestine - has a direct liaison with our brain and vice versa. If our microbiome is out of sorts and less varied, then this has been shown to also impact on mood and depression risk. Gut permeability or 'leaky gut' which is basically a gut lining that is allowing particles through into the blood stream that should have remained in the intestine and evacuated, is also linked to depression, probably via the decreased availability of Serotonin.
Serotonin acts as a neutrotransmitter, basically a messenger that relays message from one part of the body to the other. Serotonin acts in the brain, but also on the cardiovascular (heart), muscular and endocrine (hormones) systems. Serotonin has become well-known through its inclusion in anti-depressant medications that are based on Selective Serotonin Reuptake Inhibitors, despite the fact that scientists still don't know what role serotonin actually has within the brain and why lower levels of serotonin lead to depression. The only thing we do know, that in certain people using SSRIs to increase the amount of serotonin within the brain does have an effect on mood.
One thing is known, however, only 10% of serotonin is found in the brain. The remaining 90% is found in the gut. To have good functioning serotonin levels, therefore, it is key to ensure that your gut health is tip top.
Next week: Nutrition Tips to Support Gut Health and Mental Well-being.
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