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Eczema or Atopic Dermatitis
By Daniel C. Luthi
Chronic inflammatory skin disease such as atopic dermatitis, or eczema, is a common condition that occurs in 2.4 percent of the population, and affects 10 % of all children. It can first appear at any age, but often it appears during the first year of the infants’ life.
The skin around the antecubital (elbow) and popliteal (knee) fossae as well as areas around the scalp, the ears, and on the hands and fingers may be affected. The skin is often dry, red, itchy, sometimes oozing, crusting and scaling, with decreased water holding capacity, and often with accentuated furrows.
The causes are multifactoral and include inadequate nutrient intake, imbalanced intestinal flora, leaky gut, food allergies, and environmental contaminants such as air pollution and tobacco smoke. There is usually a personal or family history of atopic dermatitis, which suggests a genetic predisposition or weakness. A family history is present in 65-70 % of patients diagnosed with eczema.
The itchy, scaly, and dry skin encourages people to use lotions and creams to which they are often allergic, creating more complications. The severity of the eczema varies over time as it flares up and calms down depending on internal factors such as emotional stress, bacterial skin infections, sweat, and hormone fluctuations, as well as external factors such as heat, humidity, pets, dust, molds, pollens, toiletries, cosmetics, and wool clothing.
There is a strong connection between eczema and food allergies. Foods that can aggravate inflammatory skin conditions include eggs, cow’s milk, food additives, tomatoes, fish, goat’s milk, cheese, chocolate and wheat. These food allergies can cause damage to the intestinal lining and dysbiosis, causing leaky gut syndrome, which in turn can lead to more food antigens and sensitivity. Therefore, elimination of foods, stress, and allergens can significantly alter the course of this disease.
The diagnosis is made entirely on clinical findings by a specialist and is based on the distribution of the lesions, the duration, and a family history. The holistically oriented practitioner will also evaluate above-mentioned external and internal factors.
The medical treatment of atopic dermatitis has been and still is, sometimes for life, with corticosteroids, which suppress inflammatory reactions in the body. Long-term use of corticosteroids, like cortisone and prednisone, depresses the immune system, causing side effects like lowered resistance to infection and parasites, stomach and duodenal ulcers, thinning of bones, and other problems. Once the treatment with corticosteroidal medications is discontinued there is often a rebound effect, and the symptoms may return worse than before.
Nonsteroidal anti-inflammatory drugs:
Nonsteroidal anti-inflammatory drugs (NSAID), like aspirin, ibuprofen, and indomethacin, work by blocking prostaglandins. Some of these small protein messengers, called prostaglandins, that circulate throughout the body cause pain and inflammation, others cause healing and repair. Unfortunately, NSAIDs block all prostaglandins, which reduces the pain but also halts the healing process. Prolonged use of these anti-inflammatory drugs increases the risk of ulcers of the stomach and duodenum, and causes bleeding, damage to the mucous membranes of the intestines, and gastrointestinal inflammation.
The healing methods employed by today’s allopathic practitioners, including dermatologists, justify a more thorough evaluation of the options available to the sufferer of inflammatory skin diseases. Many factors have been identified to significantly contribute to the presence and prevalence of these conditions, and they must be considered in order to reestablish balance within the systems of the body. These factors include food allergies, environmental sensitivities, dysbiosis, Candida infections, excess intake of arachidonic acid, insufficient levels of vitamins, minerals, and essential fatty acids, and malfunctioning enzyme systems due to genetic weakness.
Importance of Nutritional Support:
An example of genetic weakness can be found in people suffering from the chronic inflammatory skin disease, atopic dermatitis. While their diet typically contains the same amount of essential fatty acids as those without the disease, in people suffering from inflammatory skin conditions, the delta-6-desaturase enzyme doesn’t work very well. This results in inadequate production of the anti-inflammatory prostaglandins, while the inflammatory prostaglandin pathways continue to work, which results in chronic, unbalanced inflammation. To only improve the patients’ diet would take a long time to correct the imbalance since not only the fatty acids of the blood and the cell membranes are out of balance but also all the fat storage cells of the body. Supplementation with EPO (evening primrose oil, a rich source of gammalinolenic acid, or GLA) bypasses the weak enzyme and supports the natural anti-inflammatory prostaglandins, resulting in a reversal of the disease. In addition, antioxidants in foods and in supplemental form inhibit the synthesis of pro-inflammatory prostaglandins and help quench the inflammatory process.
Therefore, providing essential fatty acids in the diet, as well as adequate supplementation of specific EFAs, nutrients, and herbs will support the natural anti-inflammatory pathways. This suggests that nutrition plays a most crucial role in treating chronic inflammatory skin diseases and should be an integrated part of any long-term treatment plan.
Factors in Inflammatory Conditions:
Several drugs, food additives, and environmental toxins either increase the activity of our inflammatory processes or activate them when not needed. Drugs such as allopurinol (for gouty arthritis), barbiturates (sedatives), eucalyptus (for congestion), fluorides (to control cavities), and some antibiotics (for bacterial infections) are all commonly used and are known to cause imbalanced inflammatory response. Food and drug additives (coloring agents, flavorings and flavor enhancers, preservatives, emulsifiers, and others) have been shown in several studies to cause inflammatory problems, in particular in people with chronic inflammatory conditions, such as asthma and eczema. Thus, the affected person must avoid all food additives and chemicals, and use natural household cleaning products and shampoos, soaps, lotions, sanitary pads, and other toiletries that are hypoallergenic. Also to consider are clothing, mattresses, gas stoves, carpeting, and upholstery at home as well as at work. Working with a health professional that has experience with sensitivity issues can be of great value during this stage of the healing program.
Foods that one may be allergic to must be eliminated, at least for four to six months. An elimination diet can significantly reduce inflammatory skin diseases.
Fungal infections are a common cause of eczema. In a study of 115 men and women with eczema, 85 were sensitive to fungus and after they were treated with fungal creams, oral ketakonazole, or a yeast-free diet, there was much improvement. A yeast self-test, blood testing, complete digestive and stool analysis will determine if yeast is a contributing factor in a person with inflammatory skin conditions.
The best way to normalize inflammatory prostaglandins is to decrease the production of the pro-inflammatory prostaglandins (PGE 2) by eating less land-animal fat, and to increase the production of the anti-inflammatory prostaglandins (PGE 1 & 3) by eating more fish, nuts, and seeds. Due to the fact that humans generally lack the enzyme to form arachidonic acid in the body, it is derived almost entirely from dietary animal fats, and contributes greatly to the inflammatory process through its conversion to inflammatory prostaglandins and leukotrienes.
Specific Nutrients for Inflammatory Conditions:
People with eczema generally have low levels of omega-3 and omega-6 fatty acids, and studies have shown that the conversion from linoleic acid to gamma-linolenic acid (GLA) is often impaired in people with these skin conditions. Therefore, the most effective fatty acids to control inflammation are the ones that circumvent this conversion process such as GLA (from evening primrose, flax, or borage oil), and EPA and DHA (from fish oil). These fatty acids compete with arachidonic acid for enzymes; therefore, consumption of GLA, EPA, and DHA will result in decreased production of inflammatory prostaglandins (PGE 2) and leukotrienes (LTB 4). At the same time, they also provide the precursors to the anti-inflammatory prostaglandins, the PGE 1 and PGE 3. The net effect of consuming these essential oils either in food form or through supplementation is a significantly reduced inflammatory and allergic response, and resulting clinical improvement of conditions.
A properly balanced microbial flora in the intestines is fundamental in treating eczema. There are two major components that play important parts in this delicate system:
Probiotics are the intestinal bacteria found in the healthy intestines which inhibit the growth of toxic bacteria, viruses, fungi, yeasts, and parasites, and they also aid in digestion, synthesize vitamins, reduce blood ammonia levels, lower cholesterol levels, neutralize carcinogens, and stimulate the immune system.
Prebiotics are indigestible substances that help the healthful bacteria grow. These substances, such as fructooligosaccharides, are preferred by friendly intestinal bacteria to grow and multiply, and cannot be utilized by toxic bacteria due to their chemical structure.
Until a few years ago, at a time when our soil was not depleted of nutrients, our food was grown without pesticides, it was stored without preservatives, and processing was minimal, at a time when fast food did not exist, when our lifestyle did not cause today’s stress levels, when air and water pollution was not an issue, and physical activities were a daily necessity, back then, we didn’t need to take extra vitamins and minerals. They were supplied to us through our meals, and provided sufficient protection from minimal exposure to toxins. Today’s grown vegetables and fruits, if not grown organically in healthy soil, and today’s raised animals, if not grazing on unpolluted grasses and weeds, do not provide the needed vitamins and minerals to support our various systems to cope with environmental toxins and stress and the resulting immunosuppressive conditions in our bodies. Consequently, today’s foremost experts in holistic and preventive medicine, such as Bach, Bauman, Bland, Gittleman, Lipski, Marz, Murray, Pizzorno, Tierra, Weil, and many others, all agree that a high-quality multi-vitamin, multi-mineral supplement that is taken while eating a clean, balanced diet can help our bodies to stay healthy.
Quercetin, the most effective bioflavonoid for anti-inflammation, is especially useful in decreasing inflammatory leukotrienes synthesis. These leukotrienes are 1000 times as potent as histamines in promoting inflammation, and the importance of reducing their production cannot be overstated. Excessive formation of these potent inflammatory chemicals has been linked to inflammatory diseases such as asthma, eczema, gout, psoriasis, and the inflammatory bowel diseases. Quercetin has also been shown to reduce pain and to control allergies, and it protects the cell membranes due to its antioxidant activity.
Vitamin C plays a major role in inflammation control through its antioxidant activity as a direct neutralizer of free radicals, as well as through its ability to increase production of the enzyme (superoxide dismutase) that scavenges free radicals. In well-documented studies vitamin C has also been shown to have antihistamine activity.
Zinc should be taken in a picolinate form for best absorption and utilization. Zinc is involved as a cofactor with the delta 6-desaturase enzyme system, which produces Series 1 prostaglandins,
or PGE 1. These prostaglandins are involved in regulating HCL (hydrochloric acid) production, mucus secretion, blood pressure regulation, and in reduction of inflammation. Zinc can be used orally and topically (in a zinc oxide ointment), especially in infants who have advanced inflammation of the skin, and it should be taken together with Copper so as not to cause an imbalance.
Traditional Herbs for Inflammatory Conditions:
Besides having very powerful antioxidant components, the volatile oil fractions of turmeric possess anti-inflammatory properties that are comparable to those of cortisone and phenylbutazone. Curcumin, the yellow pigment in turmeric, is even more potent, especially in acute inflammation, and while cortisone and phenylbutazone are associated with significant toxicity, curcumin displays virtually no toxicity at all. Curcumin works directly by inhibiting the production and release of leukotrienes and other inflammatory mediators, and indirectly by possibly stimulating the adrenals to release adrenal corticosteroids, and by sensitizing cortisol receptors sites, which may potentiate cortisol action.
Burdock root and seeds have been used in Chinese and western herbal medicine for many skin diseases. Arctium Lappa and its constituents support liver detoxification pathways - in Chinese medicine this is known as having heat-clearing properties - and it further has a diuretic action, which causes the kidneys to clear the blood of harmful acids. As a powerful nutritive, consisting of inulin (a polysaccaride), iron, calcium, and vitamin C, Burdock aids digestion and acts as a blood and lymphatic cleanser, which all are essential in inflammatory skin conditions. Burdock Root, just like Astragalus, is one of the herbs that are recommended for weekly or even daily use, and it is easily incorporated into congees, stews, and soups, as well as daily teas.
Silybin, a component of silymarin in the Milk Thistle, seems to exhibit the greatest degree of biological activity. Its main action for inflammatory conditions is its ability to reduce pro-inflammatory leukotrienes. Since the liver can be damaged by the action of leukotrienes, this makes it also an exceptional herb to prevent liver destruction and enhance liver functions. Silymarin also increases the glutathione content of the liver, which gives the liver an increased capacity for detoxification. Silymarin is one of the most potent liver-protecting substances known.
Ginkgo Biloba extract and the ginkgolides have been shown to be potent inhibitors of platelet-activating factor (PAF), a powerful stimulator of platelet aggregation and degranulation, which releases allergic and inflammatory components. It is also involved in other inflammatory and allergic processes such as neutrophil activation and increased vascular permeability. Ginkgo leaf extracts have been well researched and are among the leading prescription medicines in Germany and France.
Known in Traditional Chinese Medicine (TCM) as Da Zao, or Big Date, it has shown to support liver detoxification following exposure to certain substances, and it has exhibited beneficial effects for people with hepatitis or cirrhosis. It contains vitamins A, B2, and C, as well as calcium, phosphorus, and iron.
Just as gamma linolenic acid (GLA), Ziziphus Jujuba is known to enhance adenylate cyclase activity. This is due to its high nucleotide content and it results in a decreased production of inflammatory prostaglandins.
Astragalus, known as Huang Qi, is the primary herb used in Chinese medicine to tonify the immune system of the lungs, and the lungs are considered to be directly related to the skin. Astragalus, just like Burdock Root, is one of the herbs that are recommended for weekly or even daily use, and it is easily incorporated into congees, stews, and soups, as well as daily teas. It contains high levels of zinc, and the flavanoid Quercetin, and it has shown to have immune stimulant, diuretic (see Burdock Root), and antiseptic properties.
Food elimination and provocation program by Elizabeth Lipski, Digestive Wellness
This program allows all fruit (except citrus), all vegetables (except tomatoes, eggplant, potatoes, and peppers), and white rice. One can eat as much of these foods as one likes, and olive oil and canola oil can be used for stir-frying and for salads. In addition, she recommends a rice-protein, nutrient-enriched drink that helps to detoxify the body and it’s systems, and it ensures that the body’s protein needs are met. These foods are unlikely to cause food allergies, and one should feel well, possibly better than in years, following this diet for several months while the digestive system is healing. After seven to fourteen days on the elimination diet, the provocation phase is entered by slowly reintroducing foods into the diet and observing the reaction. Sleepiness thirty minutes after eating wheat, diarrhea after eating cheese, itching all over after consuming oranges, painful joints after ingesting tomatoes, are possible reactions one may observe if certain foods cause sensitivities. A familiarity with one’s body will help to identify these allergic reactions, even if subtle, and the offending foods may be tested several times to ensure accuracy.
Anti-inflammatory Nutrients for Prevention of Heart Attack and Stroke
Recent research has shown that even low-grade inflammation anywhere in the body is an even bigger trigger of heart attacks than cholesterol. A series of landmark studies, beginning in 1997, suggest that during inflammation, elevated levels of a chemical called c-reactive protein (CRP) is responsible for this increased risk of heart attack and stroke. This new evidence shows that fatty build-up (plaque) in the heart arteries – and everyone who reaches middle age has some degree of this plaque - becomes weakened by inflammatory chemicals in the blood, which renders the build-up squishy and fragile. As a result, this tissue change can prompt the formation of a clot that will choke of the blood flow and cause a heart attack. Since c-reactive protein is particularly easy to measure, experts recommend early testing, some as early as age forty, regardless of the patient’s other risk factors. Dr. Ridken of Boston’s Brigham and Woman’s Hospital who’s team conducted this study, estimates that between 25-35 million healthy middle-aged Americans have normal cholesterol but above average inflammation, putting them at unusual risk of heart attacks and strokes.
This reinforces the recommendations by holistic practitioners that everyone - especially people with inflammatory conditions - should eat a balanced, plant-based diet of unrefined, organic foods, augmented by sufficient anti-inflammatory and anti-oxidant supplements. Thus, we can potentiate the necessary factors to support the body’s natural tendency towards balanced inflammatory and anti-inflammatory pathways, as well as provide some extra help for possible genetic malfunctions.
As we have seen, there are multiple causes for atopic dermatitis such as imbalanced intestinal flora, leaky gut, food allergies, environmental contaminants, genetic predisposition, and very importantly, inadequate essential fatty acid intake, and excessive arachidonic acid consumption.
Therefore, providing essential fatty acids in the diet and reducing arachidonic acid intake, as well as adequate supplementation of specific EFAs, nutrients, and herbs will support the natural anti-inflammatory pathways. A diet consisting of fresh, organic vegetables, whole grains, nuts, and seeds, as well as clean sources of fish, poultry, and meats, is going to be essential to provide the required co-factors for proper absorption and metabolism.
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Gittleman, Ann Louise. Your Body Knows Best, Pocket Books, 1997
Lipski, Elizabeth. Digestive Wellness, Keats Publishing, 2000
Marz, Russell B. Medical Nutrition from Marz, Omni Press, 1999
Murray, Michael T. The Healing Power of Herbs, Prima Publishing, 1995
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Pizzorno, Joseph. Total Wellness, Prima Publishing, 1998
Tierra, Lesley. The Herbs of Life, The Crossing Press, 1997
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