Atopic dermatitis (AD) and its related flares are thought to be caused by the complex interactions between a wide variety of components, including genetics, immune system functioning, environment, and potentially, food choices.1 Food elimination diets have been a topic of debate when it comes to their usage for AD relief. Some individuals report that their AD seems to worsen or flare after they eat certain foods, while others report that avoiding specific food groups altogether seem to lead to relief from AD flares and symptoms. Although many of these observations can vary greatly from person to person, there has been a spark in the desire to research the way food impacts AD, and to see if certain diets, like elimination diets, can help pinpoint food-related causes of AD, and possibly reduce the occurrence of flares and their severity.
What are food elimination diets?
Food elimination diets are eating plans that remove certain foods from the diet completely. Typically, foods that are eliminated from the diet are foods known to commonly cause allergic reactions or other adverse, sensitivity reactions. Examples of these include dairy, gluten, refined sugar, eggs, processed foods, and more. There are different variations and extremes of elimination diets, ranging from eliminating one food to eliminating all potential reaction-inducing foods. When an individual eliminates all of these foods at once, they are typically re-introduced into the diet one by one over the course of many weeks. This is the most extreme version of the elimination diet, sometimes called a complete elimination diet.
It can take multiple weeks to determine the effect of removing a specific food from the diet, meaning that larger-scale elimination diets that involve both eliminating and reintroducing food may take a long time to fully implement. Since these eating plans may involve removing crucial vitamins, nutrients, and other food sources from an individual’s diet, it’s important to consult a doctor or healthcare provider before beginning one. Elimination diets can come in many forms, and are used for a variety of reasons.
Why are food elimination diets used?
The food we eat has a link to both our overall wellbeing as well as to some of the physical things we experience. For example, allergic or sensitivity reactions to certain foods may cause digestive issues, including diarrhea, bloating, and constipation. Allergy testing may help an individual discover what foods they are allergic too, however, there are many additional foods that may not test positive on an allergy test that still cause sensitivity reactions. These food reactions may also cause external symptoms like acne and AD flares. Identifying foods an individual is allergic or sensitive to may help relieve additional symptoms, such as mood disturbances (including anxiety or depression), sleep issues, chronic fatigue, arthritis, and more. 2
By eliminating certain foods from the diet, or eliminating a broad range of foods and reintroducing them slowly one at a time, it may be possible to pinpoint which foods are causing undesirable reactions. It may be possible to remove these foods from the diet altogether, for longer-lasting relief.
Food elimination diets and AD
Food elimination diets in relation to AD have received mixed reviews. It has been hypothesized that only a small proportion of AD cases are related to food-related issues, and would see a significant benefit from food elimination diets. For this reason, wide-scale, long-term food elimination diets are typically not recommended for those with AD, especially children who need vital nutrients that may be removed. These excessive elimination diets can lead to calcium deficiency, vitamin deficiency, severe weight loss, and protein malnutrition, as well as poor growth in children. Due to these negative effects, the American Academy of Dermatology (AAD) recommends keeping a food journal to identify patterns in symptom flares in relation to certain foods, and then eliminating only one or two suspected foods at a time for a period of 4-6 weeks as opposed to a broad elimination diet. 3
Some studies have pointed towards the efficacy of eliminating eggs from the diet in those who are allergic to eggs, as well as eliminating food additives in a small subset of individuals with AD.4 At this time, in addition to not recommending total elimination diets based on food allergy tests and suspicion alone, while the AAD also does not recommend the use of probiotics, prebiotics, and other supplements such as fish oils, evening primrose oil, and vitamin and mineral supplements for the treatment of AD, these are often alternative therapies that people employ who have AD and should be discussed with a healthercare provider. 3 Ultimately, more research is needed to determine the benefit of elimination diets, and at what level of elimination they could be the most helpful. As mentioned earlier, it is important to talk with your doctor or healthcare provider before starting any elimination diet on your own.
Lim, NR, Lohman ME, Lio, PA. The role of elimination diets in atopic dermatitis—A comprehensive review. Pediatric Dermatology. 8 Sept 2017; 34(5), 516-527.
Campagnolo N, Johnston S, Collatz A, Staines D, Marshall-Gradisnik SM. Dietary and nutrition interventions for the therapeutic treatment of chronic fatigue syndrome/myalgic encephalomyelitis: A systematic review. 22 Jan 2017; 30(3), 247-259.
Sidbury R, Tom WL, Berman JN, et al. Guidelines of care for the management of atopic dermatitis: Section 4. Prevention of disease flares and use of adjunctive therapies and approaches. J Am Acad Dermatol. Dec 2014; 71(6), 1218-33.
Mohajeri S, Newman SA. Review of Evidence for Dietary Influences on Atopic Dermatitis. Skin Therapy Letter. Jul-Aug 2014; 19(4), 5-7.