The link between gut health, eczema and allergies (+Week 3)
The takeaway
We are in Phase 2 of the Microbiome Diet, which reintroduces a variety of foods including eggs, potatoes, gluten-free grains, some dairy and legumes and requires 90% compliance.
Gut microbial imbalance and intestinal permeability are implicated in conditions like eczema and allergic disease.
Improving gut health may help with eczema and allergy symptoms.
Probiotics can help prevent, but not necessarily treat, eczema, but current evidence does not support their use to prevent or treat allergies.
Read on for more details!
Transitioning to Phase 2
We have completed Phase 1 of the Microbiome Diet! Now we are on to Phase 2, which is a bit more relaxed. In addition to veggies, fruits, meat, nuts, fats, herbs and spices the following foods can be included in the Phase 2 diet:
Eggs
Sweet and white potatoes, yams
Gluten-free grains including quinoa, amaranth, buckwheat, millet, oats (if made in gluten-free facility), rice (brown, wild, basmati; NO white rice),
Sheep and goat’s milk, yogurt, cheese
Kefir from any milk
Legumes, including red, black, kidney, white and green beans (*chickpeas and lentils are allowed in Phase 1; NO peanuts)
For a full list of foods to include and avoid in all Phases 1, 2, and 3 of the Microbiome Diet, check out Microbiome Diet: The Naughty and Nice.
Also, Dr. Kellman recommends following the Phase 2 diet with 90% compliance, meaning out of 21 meals and 14 snacks each week, 2-3 meals and 1 snack can be whatever you like, including foods not mentioned above. I encourage you to choose wisely and base your indulgences around wholesome foods, like pasta, high-quality bread, special cheese, homemade dessert, or a glass of wine or beer, rather than greasy, fried fast food or packaged snack foods. Your gut will thank you.
Also, take the opportunity to notice how you feel while eating both “compliant” and “non-compliant” foods. Do you feel satisfied, do you crave more, does the food provide energy, does it upset and calm your stomach, does it “hit the spot” and nourish your soul? Food does many things for us and is an integral part of our daily life and culture. Tuning in to our responses to food helps us choose the best foods and understand why we turn or crave to certain foods.
I decided to take a slightly stricter Whole 30-esque approach and will continue to avoid dairy, grains and legumes for another week or so. But I will add back eggs, sweet and white potatoes, and yams. Although I enjoy the Phase 1 focus of highly nutrient-dense veggies, fruit, meat, nuts and healthy fat, I will certainly welcome the additional protein and carb options.
My sweet tooth kicked in a bit last week, so although dried fruit is technically off-limits in Phase 1, I indulged in a bit to satisfy my craving. There are a few reasons it’s off limits: it’s a concentrated source of sugar, it’s easy to overeat and it lacks the water of whole fruit. I tend to think that we absorb water better when it comes with minerals in fruits and veggies, and indeed I felt a bit dehydrated after eating it. Whole fruit is a better option to satisfy a sweet tooth.
The main reasons the Microbiome Diet recommends avoiding eggs, potatoes, grains, dairy, legumes are to heal the gut by reducing inflammation, repairing the intestinal wall, and removing harmful gut bacteria. Proteins in grains (gluten and gliadin), dairy (whey and casein) and legumes (lectins) are commonly known to irritate the gut and increase intestinal permeability. The proteins in eggs can be inflammatory so they are removed from the diet for Phase 1. Potatoes, grains, dairy and legumes are also high in natural starches and sugars, which can feed the harmful bacteria. Goat and sheep milk tend to be more nutritious and easier to digest than cow’s milk (due to smaller fat and protein molecules and less lactose), which is why they’re included in Phase 2 where cow’s milk is still off limits (except for in kefir).
After the gut heals, these foods can certainly be part of a healthy, well-rounded diet. I think a diet based on Phase 1 foods, including vegetables, fruit, high quality meats and seafood, nuts, seeds, healthy fats like olive, flax and coconut oil and herbs/spices like turmeric, ginger, and cinnamon provides the best foundation for optimal health. The foods added back in Phase 2 offer additional nutrition and variety. Grains and legumes provide fiber that feeds beneficial bacteria, and eggs and dairy supply protein, fat and other nutrients. Fermented dairy products like yogurt and kefir are great choices for dairy since they also supply a dose of natural probiotic bacteria.
Why should we care so much about our diet? Personally, I feel better overall when I follow the Microbiome Diet. I experience a marked decrease, if not absence, bloating, fatigue and cravings as well as improved energy, appetite control and mood. For me, that strong and clear feedback tells me that high quality input means high quality output, meaning my body is functioning properly and even optimally.
Additionally, gut health, or the lack thereof, has been implicated in a variety of diseases. Dysbiosis, or the imbalance between beneficial and harmful bacteria Intestinal permeability, and an inflammatory diet both contribute to intestinal permeability, or leaky gut. Dysbiosis and intestinal permeability are linked to chronic inflammation, metabolic disease like Type 2 diabetes, obesity, depression, and atopies like allergies and eczema (for more details, see my post A Diet for the Microbes).
Gut health, eczema and allergy
Lately many readers and friends have asked about gut health and symptoms like sinus congestion or eczema. Personally, while on the Microbiome Diet last summer, my husband, a friend, and I all experienced a reduction or disappearance in our chronic sinus issues (mainly slight congestion and post-nasal drip) as well as debilitating hay fever. And, indeed, evidence supports links between intestinal permeability, dysbiosis, inflammation and conditions like seasonal allergies/hay fever and eczema.
Seasonal allergies and eczema, along with food allergies and asthma, are considered atopies, or chronic conditions caused by aberrant immune responses. The incidence of atopic diseases has increased rapidly in the developed world, pointing to environmental rather than genetic causes [1]. Much of our immune system is contained in and trained in the gut [2]. Proper colonization and support of gut bacteria, beginning at birth, are crucial for the development and maintenance of a well-functioning immune system [3-5].
Indeed, many atopies and other diseases of the developed world are associated with antibiotic use (particularly during pregnancy or first months of life), Caesarean section, formula feeding, and suburban lifestyle [6]. All of these factors limit the exposure to beneficial microbes or fail to support the cultivation of a balanced gut microbiome, which leads to dysbiosis, an imbalanced immune system, and inflammatory conditions like allergic diseases [5].
As mentioned above, gut bacterial dysbiosis is associated with atopic disease. Dysbiosis may inhibit maturation of the immune system, resulting in increased inflammation [7]. Beneficial gut bacteria ferment dietary prebiotic fiber, producing short-chain fatty acids (SCFAs). SCFAs can help decrease pro-inflammatory immune responses, which may improve allergy symptoms [5]. Patients with eczema showed lower levels of the SCFAs propionate and butyrate [8]. Mice fed a high fiber diet produced higher levels of SCFAs than mice fed a low fiber diet, had increased gut bacterial diversity and improved immune function, and were less susceptible to allergic airway inflammation [9].
Children with eczema display higher levels of intestinal permeability than those without [10,11]. Comparison of intestinal permeability in infants (<1 year) with eczema showed that infants with cow’s milk allergy had higher levels of intestinal permeability than those without [12].
Food allergies are commonly associated with eczema and elimination diets are part of many treatment strategies. However, the gut inflammation and intestinal wall perturbations that results from eating an allergenic food may be just as, or more, responsible for the flare up than the allergic reaction to the food [13,14]. Elimination diets often remove some of the most inflammatory and reactive food, like gluten, dairy, soy and others which we know can benefit our gut microbiome.
Evidence supporting probiotics to treat eczema is limited and unclear. A meta-analysis of 17 studies including 4755 patients showed that probiotics reduced the incidence of eczema in children when given to mothers during pregnancy or during early infancy, including during breastfeeding [15,16]. In general, it’s accepted that probiotics may help prevent eczema, but likely won’t treat established eczema. However, some promising studies show reduced intestinal permeability after 6 weeks of probiotic treatment [17], which may support other treatment strategies to clear up eczema flares.
Studies evaluating the use of probiotics to prevent or treat seasonal allergy symptoms are unclear. One analysis of several studies suggested a benefit of probiotics to reduce allergy symptoms [18]. [18]. A large meta-analyses show that probiotics use both during and after pregnancy reduced overall allergic sensitization [18,19]. On the other hand, conflicting studies show increased parent-reported allergy symptoms in children [16,20], and another meta-analysis of many trials show no benefit [15,21]. The timing of administration, number of probiotic strains, and evaluation of outcomes differ across studies, making it difficult to fully understand the effects of probiotics on allergies [22].
In theory, probiotics could help allergy symptoms, as children with allergies tend to have gut bacterial dysbiosis and lower gut bacterial diversity than those without [5,23]. However, the heterogeneity and correlative nature of studies evaluating gut microbiome and probiotics to treat allergies makes it difficult to draw major conclusions, other than that larger, more rigorous and prospective studies are needed.
Amy Myers, M.D., a functional medicine doctor, suggests the 4R strategy as a method to heal the gut and treat eczema. This strategy is also proposed by Dr. Kellman, providing the basis for the Microbiome Diet. As the overall effect aims to lower chronic, systemic (body-wide) inflammation, I think the 4R approach could improve seasonal allergy or sinus issues along with eczema.
Remove: Inflammatory foods that contribute to intestinal permeability and dysbiosis
Replace: digestive enzymes and stomach acids to reduce gut inflammation and prevent overgrowth of pathogenic microbes.
Reinoculate: add beneficial bacteria through probiotics and fermented food, as well as prebiotic fiber, to restore a healthy gut microbiome.
What are your experiences with eczema and allergies? Have you tried anything that helped? I'd love to hear from you!
For further reading, check out this thorough and well-researched article from the National Eczema Association.
Also my friend and fellow blogger just posted this article about a Chinese medicinal strategy for treating eczema from the inside out.
References
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Caffarelli, C., et al., Elimination diet and intestinal permeability in atopic eczema: a preliminary study. Clin Exp Allergy, 1993. 23(1): p. 28-31.
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