Patients in my dermatology clinic frequently ask me about how their diet is affecting their skin. I love these questions, because I have an opportunity to use my background in nutrition to guide patients toward a more skin-healthy diet.
Unfortunately, there are not evidence-based recommendations I can offer regarding supplements and vitamins because high-quality, non-industry studies are lacking. However, I can share some emerging theories on inflammation and the skin that encourage a diet based on whole foods. A few simple changes to your diet may not cure your skin conditions, but can mitigate them.
Skin is the largest organ in the body and it is in constant communication with the external environment as well as our immune and nervous systems. Our gastrointestinal system acts similarly. I like to think of our intestines almost as skin on the inside. What we eat turns into byproducts that, through chemical reactions, can produce signals for the immune system. In some individuals with a genetic predisposition, there are environmental triggers such as diet that can exacerbate or unmask a skin condition. Most Americans have an inflammatory diet that has been linked to diabetes and cardiovascular disease, as well as skin conditions like acne, psoriasis, eczema, lupus and autoimmune hair loss.
What should we avoid? You might be tired of hearing about the gluten-free craze but there actually is something behind it worth paying attention to. I refer to it as a craze because celiac disease, where people are actually making autoantibodies to gluten is still quite rare. The number of people with gluten sensitivities (not allergies) is increasing, and that is why you see industry marketing capitalizing on this trend. Scientists have found a receptor in the gut that when bound to gluten, triggers inflammatory pathways. Some people are more sensitive to this reaction than others. And the more processed grains we eat, the more exposures we get to gluten-triggering inflammation. Refined processed carbohydrates with high glycemic loads such as breads, crackers, tortillas and sweets also contain several pro-inflammatory byproducts. These can make inflammatory skin conditions such as psoriasis much worse. For my psoriasis and eczema patients, I emphasize trying to eat an anti-inflammatory diet with less gluten and refined carbohydrates. I also encourage them to minimize acidic byproduct foods such as red meat, and to introduce more omega-3 rich foods, fresh fruits and vegetables into their diet.
Another diet trend that is attributed to exacerbating skin conditions is the popularity of low fat dairy products. These have been linked to more severe acne. Milk proteins like lactose and caesin are irritating to the gut lining, and they alter the gut’s microbial environment. This promotes more inflammation. Low-fat milk products are thought to compound the exacerbation of acne by increasing inflammation and exposing us to more bovine (or additive) hormones in the milk products. It is thought that as the fat is skimmed off the milk it changes the molecular structure, exposing us to more hormones. I tell all my acne patients to try to minimize dairy, especially low-fat milk products.
Decreasing gluten, avoiding processed carbohydrates, and minimizing dairy in your diet are things you can do for healthier skin. Taking extreme measures and being overly dogmatic will not lead to long-term changes. I recommend that you start with one meal per day as you begin to take control over your skin health! FBN
Sara Risner-Rumohr, M.D., FAAD, is trained in medical dermatology, cutaneous oncology and cosmetic dermatology and treats patients of all ages with a broad range of skin conditions. She is board certified in dermatology and is a diplomate of the American Academy of Dermatology.
Dr. Risner-Rumohr relocated from Houston, Texas to Flagstaff in fall of 2014 because she missed both her family and the Arizona landscape. Dr. Risner-Rumohr grew up in Tucson and graduated summa cum laude from the University of Arizona. She completed her medical education at Vanderbilt University where she was inducted into the Alpha Omega Alpha Medical Honor Society. Dr. Risner-Rumohr then moved to Houston and completed a residency in Dermatology at Baylor College of Medicine. After residency, she joined a private practice group in the Houston Medical Center and was a consult staff physician for the Houston Methodist Hospital. In her spare time, she enjoys cooking, running, travelng, and enjoying the outdoors with her husband (a urologist) and their two daughters.