The Dermatologist's Guide to Elimination Diets: The Science vs. the Hype
I sometimes cringe when I hear about detox diets or elimination diets that are supposed to work for everybody with eczema, or psoriasis, or other skin diseases.
That's because elimination diets don't work that way. They have to be customized. As in so many areas of medicine, everybody's different. It all depends on your personal profile, which includes your medical history, your dermatologic history, your allergies, and other factors.
It's also important to respect elimination diets. Eliminating an entire group of foods can cut out important nutrients, which means that elimination diets can trigger their own set of problems. In children, we don't ever recommend elimination diets without the supervision of the pediatrician and likely a nutritionist.
Here's a partial list of elimination diets which may be helpful for certain skin conditions.
Detox diets and elimination diets are frequently recommended by Internet gurus and celebrities for problem skin. Unfortunately, a lot of the recommendations that are out there are well-meaning but misguided. The truth is that most detox diets and elimination diets have to be customized and tailored for your individual medical profile and for your individual skin issues.
It IS true that some of the detox recommendations out there are helpful for just about everyone. Too much sugar, for example, is definitely bad for multiple organ systems, including your skin. But even there, there are a lot of nuances that the internet gurus just don't get right. For example, consuming natural sugars in the form of whole fruit is completely different than consuming added sugar in soda.
On the other hand, there's a lot of misinformation around certain elimination diets. One elimination diet that's often misused is the gluten free diet (GFD). It is a complete misconception that everybody with skin problems needs to go off gluten. Think about it: there are literally billions of people in the world who eat gluten and have beautiful skin. However, the reason GFDs became so popular is that there are certain people with certain skin conditions who might see improvement if they swear off gluten. This includes every person with celiac disease, some people with eczema who also have a wheat allergy, some people with psoriasis who also have gluten antibodies in their bloodstream, and many people with gut dysbiosis. Based on scientific studies and clinical research, here are the elimination diets and detox diets that are recommended for specific skin conditions and specific skin allergies.
There's a strong link between diet and aging skin. Certain foods accelerate aging of the skin. This page provides more details.
Broiled meats are high in collagen-damaging AGEs
(advanced glycation end products) that will
accelerate skin aging.
This page provides more information on food and beverage triggers in rosacea.
Tomatoes contain cinnamaldehyde, which can trigger rosacea.
Foods high in added sugar, like cupcakes, can cause a rapid rise in blood sugar levels, triggering changes in hormonal levels and increasing acne.
I've seen a lot of misconceptions about psoriasis and dietary recommendations on the internet. One of the most common misconceptions that I see is around the use of gluten-free diets. Gluten-free diets can help in a subset of patients with psoriasis, but only in a specific subset of patients. They're definitely not recommended for everyone. Here's a post about some of the facts and myths on gluten-free diets in psoriasis.
High sugar, high carb foods, like cookies, are linked to psoriasis.
The role of food allergies in eczema is very complex. Many patients with eczema have food allergies, and their food allergies don't have anything to do with their eczema. In other cases, food allergies may worsen eczema. To make it more complicated, there are several different types of food allergies that can trigger flares of eczema. This page provides more details.
Dairy products, such as milk, can trigger eczema in some individuals.
Some individuals with chronic eczema (dermatitis) who are allergic to fragrance additives in their skin care products will find that certain foods seem to make their eczema worse. That's because fragrance additives are related to certain foods. While this is not the case for everyone, some people may find it helpful to monitor their reactions to fragrance-related foods. This post goes over the balsam of Peru avoidance diet in detail.
Citrus fruits contain balsams.
Some people with eczema, either hand eczema or generalized eczema, are allergic to nickel. Some of these individuals (not all) will find that there eczema worsens when they eat foods that are high in nickel. This post provides more details.
Shrimp and other shellfish are high in nickel.
Although this isn't what I would call a common allergen, some people with chronic dermatitis are allergic to propylene glycol in their skin care products. In some cases, these individuals will also have layers of their dermatitis when they consume foods that contain propylene glycol. For more details, see this post.
Dr. Rajani Katta is the author of Glow: The Dermatologist's Guide to a Whole Foods Younger Skin Diet. To receive future updates on preventive dermatology and the role of diet, sign up here.