Elimination Diets & Skin Health

Elimination Diets & Skin Health Connection?

Adverse reactions to food can often manifest as a disturbance in skin health and affect an individual’s overall well-being. A food allergy, intolerance, and/or sensitivity are examples of adverse reactions to food. The prevalence of these health conditions is quite common and is on the rise. In fact, according to the CDC (and as discussed on the National Institute of Allergy and Infectious Diseases webpage), food allergies have increased between the years 1997-2007 by 18% in children younger than 18 years of age.¹ It is also thought that approximately 60% of the population may be dealing with an undiagnosed food allergy.² The general explanation for this rise in food allergies is unknown, although one theory explored by a recent study is looking into the potential roles that the environment and gut bacteria play in determining an individual’s health and risks for food allergies.³ 

Symptoms of an Adverse Food Reaction

Adverse food reactions can cause numerous symptoms and affect multiple body systems. The body systems affected include the cardiovascular, gastrointestinal, respiratory, and skin systems. The symptoms depend on the type of food reaction and can vary in severity. 

Symptoms include but are not limited to:^2,4

• Migraines
• Fatigue
• Bloating
• Trouble breathing
• Coughing
• Rhinitis
• Recurrent infections
• Anaphylactic shock
• Skin sensitivity or rash
• Death (in the most extreme cases)

Different Types of Adverse Food Reactions 

Food allergy:⁴

• Immune system response to eating a specific food
• Symptoms occur within minutes to hours of ingestion
• IgE antibodies (special immune system proteins) are created by the immune system in response to a specific food protein
• I.e. wheat allergy, peanut allergy, etc.

Food intolerance:⁵

• The inability to properly digest a component in specific foods
• I.e. lactose intolerance

Food sensitivity:⁶ 

• Immune system response to eating a specific food
• IgG antibodies are created by the immune system in response to a specific food protein
• Symptoms can occur within hours to days after ingestion
• I.e. non-celiac gluten sensitivity

*Other reactions include toxic food poisoning and psychogenic reactions to food.²

Do Elimination Diets Help the Skin?

This relatively recent increase in food allergies among the population may explain the increased number of individuals experimenting with diets such as an elimination diet. Adverse reactions to food commonly affect skin health and can be the motivating factor for individuals to seek a change in dietary habits. The main goal of the elimination diet is to remove the most common food allergens in order to improve symptoms. Allergens are removed for a time period ranging anywhere from 2-6 weeks.⁷ Some people will remove one suspected allergen at a time and others will eliminate multiple potential allergens all at once. After complete avoidance of those specific foods, an individual reintroduction of the foods occurs. If any symptoms return after reintroduction (also known as an oral food challenge), then that food is generally accepted as problematic.^4,7

Top 6 food allergens avoided during an elimination diet:⁸

• Milk
• Wheat
• Eggs
• Soy
• Peanuts/Tree Nuts (walnuts, pecans, almonds, etc.)⁹
• Seafood

Other foods/ingredients that may be removed in an elimination diet include:⁷ 

• Corn
• Citrus fruits
• Coffee, tea, and alcohol
• Refined sugars
• Food additives
• Frequently eaten foods (any food that you consume more than 3 times per week)
• Any other known or suspected allergens

Why the Elimination Diet?

The most common methods of diagnosing food allergies are:⁴

• Skin prick test
• Atopy patch test
• Blood tests: for specific IgE antibodies against specific food allergens⁴

The issue with these tests is that false negatives are very common; this means the test may say you do NOT have a food allergy, even if you actually do have a true allergy.^2,4 There are several factors that make these tests unreliable. For example, one downfall of the tests is that the food protein prepared in the skin tests may not truly represent the whole form of the food.² The oral food challenge (as part of an elimination diet), is often needed in combination with these other tests.⁴

Warnings and Precautions with an Elimination Diet

As with any change in health, it is important to consult with a medical professional for advice and especially before starting any type of elimination diet. Food reactions can be life-threatening, making it even more pertinent to seek help. Many individuals self-experiment with an elimination diet for themselves and for their children, and this can become problematic and even lead to severe nutritional deficiencies. Some of the concerns with elimination diets are:²

• Exaggerated and severe reactions to food with the reintroduction of foods that have been eliminated
• Nutritional deficiencies and calorie deficits (especially in children)
• Withdrawal symptoms (especially for individuals dealing with alcohol and drug addictions): Headache, fatigue, irritability, increased hunger, etc.²

Elimination Diet for Skin Conditions 

The elimination diet is often initiated as an alternative or adjunct treatment for skin conditions. Food reactions can both cause and/or worsen the following skin conditions:² 

• Eczema – worsen 
• Acne – worsen
• Dermatitis Herpetiformis – cause and worsen
• Hives – cause and worsen
• Itching – cause and worsen
• Psoriasis – worsen
• And more…

For example, acne patients can selectively eliminate various food groups or foods that have been found to worsen acne severity, such as dairy and sugar. Milk consumption increases insulin and IGF-1 levels, which have been shown to contribute to acne progression via 

• Increased androgen activity and subsequent sebum production, and
• FoxO1 inhibition and resulting mTORC1 activation, which further contributes to sebum production in addition to hyperkeratinization¹⁰

Furthermore, as increased glycemic load and carbohydrate intake are positively associated with acne severity,¹¹ elimination of carbohydrates characterized by high glycemic indices is another strategy to reduce lesion quantity and severity.¹⁰ Similarly, survey responses among 1,206 patients with psoriasis found 53.4% of patients to report skin improvement with reduced gluten intake,¹² suggesting a gluten-based elimination diet to be a potential therapeutic strategy for psoriasis. In contrast, a study including 85,185 patients with psoriasis did not find dietary gluten intake to be a risk factor for psoriasis,¹³ and the precise role of gluten in the pathophysiology of psoriasis remains unclear. However, a 2000 study observed psoriatic area and severity improvement with a gluten-free diet, specifically among patients who had antibodies to gliadin, a component of gluten.¹⁴ As patients lacking gliadin antibodies did not improve, this suggests a gluten-free elimination diet may be beneficial for a specific subtype of psoriasis patients.

Other Factors to Consider

There are multiple factors to consider when addressing skin health and adverse food reactions. For example, lifestyle and environmental exposures can also become issues. A theory to consider, which has been mentioned by Alan Gaby, M.D., is that an individual’s food allergies may be exacerbated with exposure to possible chemical allergens in the environment.² In other words, if your exposure to chemical allergens in the environment is high, your “allergic load” may increase and worsen your food allergies.² Eating a diversified diet by rotating your food choices can often also help to lower your risk of food allergies.² More detailed research on the elimination diet and its effect on treating specific skin conditions is still ongoing, and there are large possibilities for new discoveries on alternative treatments for adverse food reactions in relationship to skin conditions.