Elimination Diet Basics for Skin Conditions
Your Skin Deserves Better
There is something that you do every day that can create problems for your skin. To you, your skin problem may be called psoriasis, eczema, rosacea or acne, but to your skin it is an inflammatory reaction, and the source of that inflammation may very likely be the foods that you are putting in your mouth, into your digestive system.
Systemic inflammation and many common skin diseases can be the result of, or be made worse by the foods that we eat and the lifestyle we choose to follow. One problem has long been how to decide—of all the different foods you eat—which one or more is causing the chronic inflammation and skin eruptions.
Adopting a plant-based, whole foods diet, as promoted in Deirdre Earls's book Your Healing Diet, is the foundational first step towards reversing systemic inflammation. A gluten-free and/or casein-free diet, that is, one that eliminates foods from the wheat tribe and dairy foods, can also offer systemic anti-inflammatory benefits to those with chronic skin disease.
Uncovering food allergies and intolerances poses a challenge. Diagnostic tests can be expensive, unreliable, and difficult to interpret. The most effective and affordable option is to strictly remove the suspected foods from your diet and observe changes.
The Difference Between Allergies and Intolerances
While there is agreement in medical circles that food allergies exist, there is tremendous debate in the medical community as to what constitutes a true food allergy.
That's partly because what happens in the body when it has an adverse reaction to a food you're eating can get very complicated. It's useful to keep in mind that sometimes the body's reaction is immediate and sometimes it is delayed, and sometimes the body will "learn"—and can even "unlearn"—to respond to subcomponents found in the foods you eat.
From the functional medical standpoint, food reactions can be classified in one of three basic ways:
- food allergy
- food intolerance
- food sensitivity
What's important is finding a way to discover your food allergies, intolerances, and sensitivities, as that information can be the key to clearing up your skin condition. But proper diet is more than just identifying and eliminating suspected or verified food allergies and intolerances; it's eating well, every day, to the very best of your abilities, as well as avoiding those things that push your immune system to the tipping point.
Food allergy. The first type of food reaction is a food allergy. In a food allergy, your body responds to an allergen found in the food you are eating as if it were a foreign substance, and the immune system mounts an attack against that allergen.
Much of this response involves components of the body's immune system called immunoglobulins. Specifically, production of the "E" type of immunoglobulin, or IgE, causes the most extreme allergenic response. The most dire form of this type of food allergy occurs when an anaphylactic reaction develops. Two of the foods we often hear about causing anaphylaxis are peanuts and shellfish. This type of reaction can produce hives, difficulty breathing, and even shock and death.
Another type of food allergy occurs that is less dramatic than an IgE reaction, and slower to develop. These reactions can produce sneezing, headaches, and drippy nose, and are caused by another immunoglobulin, called IgG.
The most common food allergies are to proteins found in eggs, seafood, dairy, shellfish, soy, wheat, tree nuts, and peanuts.
Food intolerance. Food intolerances are different from food allergies in that they do not necessarily invoke an immediate immune response to a protein found in the food. Instead, they may result from an inborn or acquired inability to digest a particular component of a food. The classic example of a food intolerance is lactose intolerance, where the body does not produce the enzyme lactase, and cannot break down, digest, or utilize the sugar found in dairy products.
Many food intolerances are metabolic or genetic in origin, such as the enzyme deficiency of lactose intolerance. Many times they amount to more than just lacking an enzyme, though. They can be transient in nature, developing over time but also sometimes resolving, depending upon what other burdens the body is carrying. And while the immune system may not come into immediate play in these types of reactions, if exposure to the provocative food continues, food intolerances will invoke inflammation and disturb immune function. They can also generate all the downstream problems that go hand in hand with inflammation and immune dysfunction.
Again, there is much dispute in the medical community as to what constitutes a food intolerance. A food intolerance may be regarded with some suspicion as a diagnosis by the majority of doctors. Most would agree that there is such a thing as food intolerance, but they would argue that it affects relatively few people.
Food sensitivity. This third main type of reaction is a big one—you are sensitive to something in or on a food. A sensitivity can produce myriad uncomfortable or unpleasant symptoms and it can, again, be something that arises and persists, or resolves over time. You can be sensitive to almost anything about a food, especially nowadays, with our industrial food chain, but these are the two main categories of food sensitivities:
- Pharmacological. This type of reaction is the result of either natural compounds present in the foods (such as amines, salicylates, glutamates) or to preservatives, emulsifiers, colorings, and other food additives. These compounds can create a reaction similar to a drug side effect in people who are sensitive to these chemicals.
- Toxic. A toxic reaction may be due to various forms of contamination of food, including toxins found in herbicides, fungicides, and pesticides; bacteria (or some other organism) contaminating the food; or even the result of toxins produced by bacteria in your gut.
From the point of view of your body and your skin, it doesn't really matter if you have a food allergy, or a food intolerance, or a food sensitivity—the end result is the same: inflammation. Sometimes, or sometimes over time, skin eruptions also become a problem; however, many people with food allergies, food intolerances, and food sensitivities do not experience symptomatic skin problems or skin eruptions.
A number of other symptoms besides skin conditions can tip you off to the possibility that you're dealing with a food allergy, intolerance, or sensitivity. These may include headaches, acne, asthma, diarrhea, joint pain, sinus congestion, fatigue, and even depression and anxiety. You may also experience constipation, or fluctuating constipation/loose stools, hyperactive disorders, insomnia, self-limiting of particular foodstuffs, ear infections, or cognitive dysfunction, including fuzzy thinking and memory loss. Over 300 symptoms are associated with gluten intolerance alone!
Many Paths to Uncover Allergies
Uncovering which foods you are allergic to can be difficult, expensive, and unreliable. Medical techniques for determining food allergies do exist and fall into two general categories: challenge and immunological testing. Because they can be simultaneously expensive and often unreliable, the most affordable and effective "test" is an elimination diet.
Challenge test. In a challenge test, a small portion of the suspected allergen is tested by injecting or scratching into the skin:
- Skin prick test. Potential allergens are tested by scratching them into the skin. Usually the patient has to wait 24 hours to return, at which time the reaction is noted for size and severity.
- Intradermal test. This type of testing is similar to skin prick test, only the allergen is injected into the skin.
Immunological testing consists of drawing blood, exposing portions of the blood to allergens, and then measuring the body's reaction to those allergens. The three main types of immunological allergy testing are:
- ELISA: enzyme-linked immunosorbent assay
- RAST: radioallergosorbent
- ImmunoCAP: immunoassay capture test
While all these tests are somewhat effective for finding food allergies, they do nothing to help uncover food intolerances and sensitivities. If you are looking to discover the root of food allergies, as well as food intolerances, and food sensitivities, there is one way to go: an elimination diet.
An elimination diet removes the most common food allergens and problematic foods, then methodically reintroduces those foods one by one back into the diet. This is the best way to uncover food allergies, food intolerances, and food sensitivities.
One reason why an elimination diet works well is because it involves testing the food exactly the way you are used to consuming it and is, therefore, using your body as the measure for what is good for it and what is not. The tests widely available today are simply incapable at this time of adequate accuracy because so much remains unknown about the complexity of the immune system and its connections to the gut.
The other benefit of an elimination diet is that it helps to determine whether the symptoms you have are diet-related or possibly caused by another process. Your symptoms may start to improve within a few days of beginning on an elimination diet if food allergies or intolerances play a role. If you continue to steer clear of problematic foods and pursue other helpful measures your body will have a chance to heal. But it may take some time: it's important to understand that it can take as long as 2-5 years for the gut to heal from gluten intolerance, for example, and sometimes even 2-5 years isn't enough time if you've been eating it for many decades. For a skin condition such as eczema, or other rash-type eruptions such as psoriasis or rosacea, it can take many months for a full recovery.
How to Follow an Elimination Diet
An elimination diet typically last several months, and involves complete removal of a suspected food from your diet. It is best to spend at least 10 days without the food you are testing before reintroducing the food.
There are a number of ways to conduct an elimination diet, but we'll provide two basic examples: the simple and the complex.
A simple elimination diet. This is probably the best place to start if you have never tried an elimination diet before. In this type of diet, you simply avoid one or more foods that you consider to be the cause of your problem. Typically, people have more than one allergy, intolerance, or sensitivity, so trying one food at a time may not suffice.
One of the simplest ways to begin is with strict removal of gluten (wheat tribe proteins) and casein (milk protein) first, as we find these are the most frequent culprits in skin disorders. If other specific foods are already highly suspected due to negative history with them, then remove these other foods, too. Alternatively, all the most common allergens can be removed at the same time, if you suspect your problems involve true, more wide-ranging allergies. This means no egg, seafood, milk, shellfish, soy, wheat, tree nuts, or peanuts for at least 10 days before reintroducing these foods.
To recap, in our experience at DermaHarmony, gluten and casein are the most common and damaging of the abovelisted food groups that render allergenic-intolerance-sensitivity responses. Diagnostic tests too often give false negatives, thereby delaying or complicating potential recovery. Gluten and casein in some individuals wreak systemic havoc, and the other foods are much less often or even very rarely sources of systemic disturbance leading to skin disorders.
More complex elimination diet. This type of diet is best used for people with severe food reactions, or for people who have many symptoms or a more serious form of a disease.
The complex elimination diet removes the following:
- Food additives: including monosodium glutamate (MSG), artificial sweeteners, preservatives, artificial flavors, and all artificial food colorings.
- Alcohol: including beer, wine, and hard alcohol, but also including things like vanilla extract, Angostura bitters, mouthwash, cough medicine, and even homeopathic medicines that contain alcohol.
- Citrus fruits: oranges, tangerines, grapefruit, limes, lemons, and other citrus fruits.
- Shellfish: including lobster, crab, mussels, clams, scallops, and other shellfish.
- Nuts: tree nuts, including cashews, pecans, walnuts, pistachios and other tree nuts; as well as groundnuts (peanuts).
- Corn: including corn oil, high-fructose corn syrup, vegetable oil, corn chips, popcorn, corn starch, and other corn-containing foods.
- Dairy: including milk, cheese, butter, cottage cheese, whey, yogurt, kefir, sour cream, and other dairy foods.
- Soy: in all its forms, including textured soy protein, tofu, tempeh, edamame, soy sauce, and soy milk.
- Eggs: both the yolk and the whites.
- Gluten: a protein found naturally in grains of the wheat tribe, but also present through contamination in many other foods. Avoid pasta, flour, breads, cereals, cookies, and other foods made with gluten grains. Grains found to contain gluten include wheat, kamut, spelt, triticale, barley, rye, and sometimes oats.
- Sweeteners: honey, maple syrup, white sugar, brown sugar, fructose, dextrose, maltose.
Now, before you look at this list and think you could never, never, eliminate all these foods at once, keep in mind that the list is intended to provide guidelines, not to be so overwhelming that you'd run away from the entire idea just reading it! Very, very few people can eliminate all of these foods all on their own, and perhaps should only attempt to do so under the oversight of a caring, knowledgeable clinical nutritionist or practitioner of functional medicine. Perhaps most importantly, it's rarely necessary to do all of this simultaneously or perfectly to achieve progress.
Food cravings are another way to uncover a food allergy or intolerance. Strange as it may seem, we often crave foods we are allergic to. Search out your diet and remove any of the foods you feel especially drawn to for your elimination diet.
Foods that may be allowed include:
- Grains: Rice and millet, including rice cakes or crackers made from acceptable grains.
- Grain substitutes: Including amaranth and quinoa (often mistakenly categorized as grains).
- Fruits and vegetables: Most fruits and vegetables are generally okay except for citrus fruits and strawberries. Salad greens are generally excellent choices, and we highly recommend dark green leafy vegetables. Some individuals have an inflammatory response to nightshade vegetables, which include tomatoes, tomatillos, potatoes, peppers, and eggplant—you may want to remove these (especially if your symptoms include arthritis and/or arthritic pain).
- Beans/legumes: All are okay—except some people may react to soybeans. Soy allergies are rare, however, and most people do not have problems with soybeans. We encourage occasional organic soy intake for virtually everyone.
- Protein: Meats are generally okay. Although they are rarely a source of allergy or intolerance, they are decidedly pro-inflammatory, and therefore should be routinely minimized on an anti-inflammatory diet. Processed, chemical-laden meats should be avoided altogether.
Reintroduction of Foods
The key to success with an elimination diet is in the careful, deliberate reintroduction of foods. You spend 10 or more days away from your food allergies or intolerances, and when you reintroduce the foods, it becomes very clear whether they are a problem for you or not.
The best way to reintroduce a food is to test one food at a time, waiting to see if there are any reactions. A reaction can take the form of any sort of symptom, ranging from sinus drainage to excess gas, diarrhea, headaches, a return of a skin condition, or a more extreme allergic reaction.
Typically, you choose the food you are most craving at the time for reintroduction, then eat one portion of it, wait 4 days, and observe. Do this again two more times. With no negative reaction you can then reincorporate the food into your diet—but only eating it every 3–4 days. Proceed this way through all foods that you have been avoiding until you have a group of foods to avoid and a group of foods that you can enjoy without having to worry about whether they bother you or not.
It is not uncommon to need to repeat this whole process one or more times, as your food allergies and intolerances will change as you become healthier.
Challenging but Worth It
An elimination diet can be quite challenging, as it is hard to avoid so many foods that we eat every day. The effort, though, is well worth the results. Uncovering food allergies and food intolerances leads to a healthier you and a general lessening—or complete removal—of many skin conditions.
You are a unique individual with a unique set of allergies, intolerances, or sensitivities that may or may not change over time. You have a unique complement of genes, internal conditions, and environmental conditions, some of which are ever-changing. Very often simply removing the gluten and casein strictly while implementing a quality, pervasively plant-based, whole foods diet can be adequate to manage or reverse skin disease and optimize total health.
How We Help
At DermaHarmony, our goals are to educate chronic skin care suffers about dermatology, share what contributes to health and wellness, and support our readers in any way we can. Our programs promote healthy skin with nutritional supplements, topical treatments and dietary guidance. Learn more about our programs or call us toll-free at 1-800-827-3730. Our Support Desk is open 9:00 a.m.–6:00 p.m. ET, Monday-Friday.
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Principal Authors: C. Lucida, DermaHarmony Science Editor
with contributions from Deirdre Earls, MBA, RD, LD
Date of Publication: 01/12/2009