Got Eczema? Here's Why You Might Want to Try an Elimination Diet
A nutritionist explains how to identify foods that trigger your eczema flare-ups.
If you have eczema, I bet you’re willing to do just about anything to soothe your itchy, irritated skin. Unfortunately, many of the topical remedies for this condition offer little relief. But an “inside-out approach" focused on dietary changes may help considerably.
If you search for “eczema diet” online you’ll find a number of different protocols. But the standard approach is to begin with an elimination diet, which entails cutting out foods that may be triggering inflammation for at least four weeks, sometimes longer.
Most elimination diets start by nixing the top eight allergens: wheat; milk and milk products (think cheese and yogurt); eggs; soy; fish; shellfish; tree nuts (almonds, walnuts, pistachios); and peanuts. However, an elimination diet for eczema typically adds additional layers, such as all sugary and processed foods and anything artificial; gluten or possibly all grains; alcohol; caffeine; nightshade vegetables; seeds; and foods that are high in histamine.
Histamine causes an inflammatory response in the body, which is why anti-histamine medications are used for allergy relief. Some foods are high in histamine or trigger histamine release, including avocado, tomatoes, spinach, pickled or canned foods, pulses, nuts, cheese, chocolate, and vinegar.
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By this point you may be thinking, “Yikes, what can I eat on this plan?” The good news is that an elimination diet isn’t a forever diet. In the first phase, a number of foods are nixed. But after 30 or more days, the excluded foods are added back one at a time.
If the reintroduction doesn’t result in the recurrence of symptoms, the food may be rotated back into the diet, although possibly not as a daily staple. Some of my clients find they don't tolerate dairy and gluten well, but can eat chickpeas, avocado, or nuts a few times a week without suffering a flare-up. What works for one person may be different for others.
It's also important to note that during the elimination phase, what you consume is just as important as what you don’t. Eating anti-inflammatory, whole, fresh foods, and a diet balanced in macronutrients (protein, fat, and carbs) is essential. A nutritious diet not only supports immunity and supplies nutrients involved in skin maintenance and healing, it also improves the health of your gut, which is critical for immune function.
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If you're considering trying an elimination diet, I can’t overstate the value of working with a professional throughout the process. Some of my clients who’ve tried elimination diets on their own wound up with too few calories, or not enough protein or fat. Those imbalances can weaken immunity, prevent improvements, or even worsen eczema.
A dietitian can also help you identify hidden or sneaky sources of things that need to be eliminated. For example, while corn is a plant, it’s categorized as a grain, not a vegetable. So if you’re going grain-free, you need to skip corn too.
Finally, a dietitian can help you meal plan, offer recipes, monitor your symptoms along the way, lend support, and guide you through the reintroduction phase. (You can search for an RD in your area through the the Academy of Nutrition and Dietetics’ online referral service.) An elimination diet is a big commitment. But identifying and managing your dietary eczema triggers has the potential to transform your skin, and your quality of life.
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That said, dietary changes are not a panacea. Eczema is a condition I struggle with myself, and even when my diet is spot on, I still get flare-ups. Mine are primarily triggered by stress, a lack of sleep, or both. In other words, diet alone isn’t the only solution.
Bottom line: Because tests for food allergies and sensitivities can be imprecise (I’ve personally had results come back as inconclusive while I was still battling flare-ups), an elimination diet is one of the most effective tools for uncovering precisely which foods are at the root of chronic inflammatory problems like eczema. But a healthy overall lifestyle that includes stress management (through techniques like meditation, acupuncture, and yoga), healthy sleep habits, and positive social support are also indispensable pillars of wellness.
Cynthia Sass is Health’s contributing nutrition editor, a New York Times best-selling author, and consultant for the New York Yankees.