When it comes to eczema and diet, I'm often asked 'what should I stop eating?' Whilst my preference - as detailed in both my books Radiant and Skin Healing Expert - is always to eliminate as many trigger foods as possible and then slowly reintroduce them, many people are reluctant to get so restrictive.
A 2017 review published in The Lancet reported that up to 81% of people with eczema were found to have some form of food allergy, highlighting the importance of considering diet when it comes to naturally treating eczema.
Allergy or Intolerance?
Food allergies can range from mild to extremely serious. When a particular food triggers an allergic reaction, our immune system responds by attacking substances that the body can’t tolerate. Immediately after eating a food you're allergic to, you might notice symptoms such as itchy rashes or swelling, especially around the face and throat. Severe allergies can trigger an allergic reaction called anaphylaxis, which is a life-threatening occurrence that can stop breathing and lead to a loss of consciousness.
The symptoms of a food intolerance primarily affect our gastrointestinal system. An intolerance is less serious than an allergy, but it can be a recurring problem. If you have a sensitivity to a particular food or food group, you might experience one or more of the following:
- Abdominal pain or bloating
- Stomach cramps
- Nausea or vomiting
- Headaches or 'cloudy' brain
- Skin flares or rashes
It is possible to conduct allergy and intolerance tests to determine a comprehensive list of potential problems. Your doctor might be happy to assist, but quite often this is something you will have to pay for privately. If it's something you'd be interested in, do reach out to my naturopath Jo at Amaranth who can talk you through the options. (let her know I sent you!)
A less expensive option would be to keep a food journal. It's important to be strict with yourself when it comes to taking notes, as reactions are not always immediate. But a food diary is a useful tool to look back on when trying to establish correlations between flares and foods.
Foods and Eczema
For many years the correlation between diet and eczema were often dismissed by health professionals. The number of studies conducted in recent years connecting diet and gut health with our skin are much more encouraging.
In 2017 this study highlighted the benefits of a food exclusion plan for eczema patients, with eighty seven percent of participants confirming they'd tried eliminating foods to look for improvements. Out of this group, patients most commonly tried eliminating junk food, dairy and going gluten-free. The best improvements in skin were reported when;
- removing white flour products 53.6%
- eliminating gluten 51.4%
- excluding nightshades 51.4%
Almost eight percent of participants also discussed adding certain foods to their diet, with over half including more vegetables, fish oils and fruit. The best improvements in skin were noted when adding;
- vegetables 47.6%
- organic foods 39.5%
- fish oil 35%
Sadly, despite over ninety percent of patients believing it was important for their doctor to discuss the role of diet with them in managing skin disease, only a third confirmed they'd spoken to their dermatologist about trigger foods.
Top Ten Trigger Foods For Eczema
As you know, we skin sufferers all differ slightly in our triggers and the things that have a tendency to exacerbate and flare our conditions. I've included the foods below that I consider our top ten triggers for eczema according to scientific research and my experience in speaking with thousands of eczema sufferers. It's important however to consider personal experience when it comes to diet correlations, and this is where keeping a food journal can prove invaluable.
Let's begin with a group of foods many people associate as being potentially problematic for their skin - dairy. Dairy products are a type of food produced from the milk of mammals - most commonly cattle (cows), water buffalo, goats, sheep, or even camels! We're talking milk, cheese, yoghurt, cream, ice cream and foods containing these ingredients like milk chocolate or pizza.
Given an increasing awareness of the link between diet and health, many patients are becoming concerned that dietary factors can trigger their eczema, and whilst the connection was denied by experts for a long time, more recent research has in fact found that dietary factors can indeed exacerbate and cause atopic dermatitis.
A common response I get to the suggestion dairy is best avoided for eczema patients, is 'where will I get my calcium?' We most definitely do not need dairy for calcium, and some studies show it can actually weaken our bones. Check out these amazing plant-based sources instead.
There are also a myriad of amazing vegan dairy-free alternatives, including lots of independent vegan cheese producers such as Tyne Chease, delicious organic ice cream options like Booja Booja, and a wide range of milks including almond, coconut, hazelnut, cashew nut and more!
Sometimes mistakenly grouped in with dairy, eggs are not in fact a dairy product, but can still pose a problem for people with eczema. Interestingly studies show they are six times more likely to cause a trigger response in infants with eczema, so definitely worth eliminating in little ones. Although this study also reveals a potential correlation in adults.
If eggs are something you're planning to eliminate, there are viable substitutions. Something called 'flax egg' (a simple mixture of ground flaxseed and water) can be used as a substitute in baking, and recipes like this one provide a protein rich substitute for scrambled eggs.
3. Balsam of Peru
You might not have heard of 'Balsam of Peru', or even be aware of this as a potential eczema trigger, but as highlighted by this 2005 study, it can be a problem for patients. Sourced from the bark of the Myroxolon balsamum tree, a plant native to El Salvador, it's a sticky liquid that smells deliciously sweet.
Balsam of Peru scent comes from a combination of vanilla and cinnamon, this is because it contains 60% cinnamein (a blend of cinnamic acid and vanillin). Interestingly it also contains essential oils similar to those found in citrus fruit peel, which can also be potentially triggering for eczema sufferers.
Perfumes, cosmetics, lip balms, mouthwashes, insect repellents and even cough medicine should be checked to ensure they don't contain this potential allergen, and if you think it might be a problem for you, you should definitely avoid Tiger Balm which often contains it.
I usually discuss avoiding tomatoes for patients battling psoriasis. Tomatoes are part of the nightshade family. They're related to the plant 'deadly nightshade' and contain something called 'alkaloids' which can trigger an unwanted immune system response. Whilst scientific studies might be lacking, anecdotally people with lupus, psoriasis and arthritis often see a significant improvement through avoiding nightshades in their diet.
When it comes to eczema, the reason I recommend avoiding tomatoes is because they are a rich source of the top three eczema triggers: salicylates, amines and natural MSG. These can be the most problematic chemical triggers for eczema and definitely worth avoiding.
If you're excluding tomatoes, it's obviously important to avoid foods and sauces contain tomato as an ingredient. This includes ketchup, pasta sauces, curry sauce, bolognese, BBQ sauce and more. Both my books feature my popular recipe for tomatoless sauce, which you can also find via my Instagram on IGTV.
5. Oranges and Citrus
Oranges and orange products including clementines, tangerines and orange juice are a rich source of two itchy chemicals: salicylates and amines. According to a 2006 study, 36% of eczema sufferers experience a worsening of eczema symptoms when they eat amine-rich foods such as oranges.
Lemons, grapefruit, cumquats and mandarins might also pose a potential problem when it comes to triggering eczema flares. These citric fruits are especially important to avoid if you are know you're allergic to Balsam of Peru (see number 3 above).
Citrus peel is the second-most commonly reported cause of dermatitis flare-ups. Considered a potential irritant, it may cause contact urticaria with hand-dermatitis reported in food handlers who became sensitised to lemons. If you are buying lemons in your food shopping, don't forget to look out for 'unwaxed and organic', as citrus fruit peel is commonly waxed and dyed, so sensitisation may in fact be due to carnauba wax or synthetic dyes as opposed to the lemon itself.
You might have heard monosodium glutamate (MSG) talked about in reference to Chinese Takeaways. It's a common additive added to savoury foods and a natural version of glutamate can also occur in tomatoes and cured meats.
The synthetic form of MSG is not a particularly pleasant ingredient and studies show it to be associated with asthma, headaches, urticaria, rhinitis, psychiatric disorders and convulsions.
According to the American Nutrition Association, a quarter of the US population have adverse reactions to 'free glutamic acid', a source of MSG present in many pre-packaged foods. Most people don’t realise they’re sensitive to flavour enhancers and children are very commonly affected.
Frequent consumption of MSG can lead to a reduction in our stores of glutathione. Glutathione is an important antioxidant enzyme which is needed by our liver to help it carry out it's important detoxification work. Glutathione also keeps our skin looking plump and radiant. When glutathione is reduced, our liver's ability to function is impaired, and this can increase sensitivity to chemicals which can worsen eczema symptoms.
Not only present in takeaway foods, MSG and flavour enhancers are often added to packaged soups, savoury biscuits and chicken salted foods. Lots of these foods are aiming to label themselves 'low sugar' or 'low salt' and would therefore be tasteless unless they have an added flavour enhancer - this is where MSG comes in. I recently noticed them in the Snack a Jacks ingredients list.
7. Peanuts and Other Nuts
Peanuts are probably one of the most commonly referenced foods when it comes to a discussion about allergens. A peanut allergy can be serious and even life-threatening.
When someone develops a peanut allergy, the allergy tends to be with them for life. Precautions include diligently reading labels, carefully avoiding certain foods, and steering clear of restaurants. You might even have heard announcements on public transport asking passengers to avoid consuming nuts because somebody with a serious allergy is on board.
According to Graham Roberts, MD, a pediatric allergist at King's College London, more than twenty percent of very young eczema patients below the age of 12 months, already present an allergy to peanuts.
The study involved 640 infants aged 4-11 months with eczema and the results presented at the annual meeting of the American Academy of Allergy, Asthma and Immunology revealed:
- 23% of infants were sensitive to peanuts
- 22% were sensitive to sesame seeds
- 16% were sensitive to brazil nuts
- 20% were sensitive to hazelnuts
- 21% were sensitive to cashews
- 14% were sensitive to almonds
Soy is a product of soybeans and considered a common food allergy. Soy allergy often starts in infancy, with reactions to soy-based infant formula. Although most children grown out of it, some carry the allergy into adulthood.
The most common soy products include soy sauce and vegan protein sources such as tofu, miso, tempeh and edamame. Some packaged foods such as meat products, baked goods, chocolate and breakfast cereals, may also contain soy.
With a soy allergy, our immune system identifies certain soy proteins as harmful, this triggers the production of immunoglobulin antibodies to the perceived threat. Histamine is partly responsible for most allergic responses and symptoms of a histamine response can include:
- Tingling in the throat or mouth
- Itchy skin, hives, eczema or red skin flushing
- Swelling of the face, lips or tongue
- Difficulty breathing and blocked sinuses
- Diarrhea, tummy ache, nausea or vomiting
More extreme signs and symptoms include anaphylaxis and immediate medical help should be sought.
9. Wheat and Gluten
Like many other skin conditions, eczema has long been associated with gluten sensitivity. This 2015 study looked at people with non-celiac gluten sensitivity who struggled with skin problems. The study noted that participants skin improved significantly within about one month when they adopted a gluten-free diet.
A 2017 article published in the Journal of Dermatological Treatment, surveyed 169 patients with eczema. Over half of those questioned who cut gluten from their diets, reported an improvement in their eczema symptoms.
This 2013 study also found that 80% of those surveyed saw an improvement in their skin by following a hypoallergenic diet which included eliminating gluten.
Whilst not strictly an allergen, foods high in sugar can certainly trigger eczema flare-ups. Eczema is considered an 'inflammatory skin condition' and sugar causes our insulin levels to spike, which in turn can result in inflammation.
When it comes to eating sugar, you might notice an immediate reaction to sweets or sugary drinks that manifests as itching and redness, but excessive sugar can also exacerbate chronic inflammation, meaning the problem builds up long-term.
Sugar also negatively impacts our natural balance of flora - the healthy microbiome in our gut - because it encourages harmful, sugar-loving yeasts to thrive. Taking a good quality probiotic free of added sugars like this one can help to redress that balance.
Do you notice any specific trigger foods that exacerbate your eczema? Is diet something you've discussed with your dermatologist and were they receptive to the conversation? Share your experience below.