Diet and Dermatology

As the saying goes, you are what you eat. The food we eat is broken down and nutrients are absorbed through the gastrointestinal tract then delivered to where they will be needed. One of those places is the skin.

We cannot live without food, so it can obviously affect our health in both good and bad ways. Whether it’s not having enough food, having too much food, not getting enough of certain nutrients, getting too much of other nutrients, food allergies, or consuming food that has traces of toxins, pesticides, hormones, plastics, heavy metals, or any other material that can negatively affect our health. Given that we know our bodies require food for life, it makes sense that we should be consuming the most high-quality, nutrient rich foods that are available. Yet many of us may choose food with convenience and speed over healthier options that may take more time or energy to prepare. It is pretty common knowledge that a standard American diet will lead to health problems, but how has research shaped our diets and eating habits?

When dietary research became more widespread, it became necessary to develop ways to quantify the health of each individual food, in order to apply it to health properties of a diet as a whole. These continue to help create guidelines for healthy eating and dieting. The Healthy Eating Index (HEI) is one of these measures of diet quality that is used to evaluate links between dietary patterns and states of health or disease. The Dietary Approaches to Stop Hypertension (DASH) diet was initially developed as a way to control high blood pressure. In reference to dietary effects on dermatology, most of the research is done from a pathological perspective, trying to determine if the things we consume have an effect on a specific condition. For example, the effects of milk on acne.

The following highlights some of the effects that diet can have on certain skin conditions:

Skin Cancer

Several studies have evaluated the impact of nutritional intake on skin cancer. In the case of melanoma, many of the positive risk factors seem to be related to gender. A comparison of different dietary indices shows that diet quality may play a role in the development of melanoma among women.[1]Specifically, glycemic load may be associated with a risk of melanoma in females.[2]

Alcohol use is also associated with an increased risk of developing melanoma.[3,4]Alcohol can cause DNA damage, alter cellular metabolism, act as a photosensitizer, lead to the production of reactive oxygen species, and alter immune function.[5-9]

Low-fat diets have been thought to lower the risk of non-melanoma skin cancer (NMSC), and even some research projects have shown a decreased rate of NMSC and actinic keratoses (precancerous skin lesions) in participants with a low-fat diet,[10-12]but several studies, including a large randomized controlled trial, failed to show an association between dietary fat intake and NMSC.[13-15]

Eczema

Allergen avoidance is paramount for the treatment of eczema. When the allergen is food, it becomes slightly more difficult to manage. Food avoidance and elimination diets are beneficial for patients with eczema who also have a food allergy that has been diagnosed with the gold-standard oral food challenge.[16]Unless monitored extremely closely by a healthcare professional, general elimination diets for all patients should be avoided (especially in early childhood) due to the risk of nutritional deficiencies, added emotional stress to the patient, and possible risk of anaphylaxis upon re-exposure to previously tolerated foods.[16-19]

Not all benefits of diet for eczema come from the avoidance of foods. In certain cases, adding certain foods to the diet can be beneficial. An epidemiological study found that 4-6-year-old children who consumed nuts had a 61% lower risk of developing eczema.[20]

Possibly the best place to begin management of eczema is during pregnancy and very early childhood. Maternal supplementation with probiotics during late pregnancy and breastfeeding can reduce the rate of development of eczema in children.[21]Maternal consumption of free sugar during pregnancy may increase the risk of the child developing atopic conditions like eczema.[22]

As for breastfeeding, there is an increased risk of eczema associated with infant consumption of breast milk that has higher concentrations of transforming growth factor beta (TGFbeta).[23]TGFbeta is a secreted protein that helps to control cell differentiation, proliferation, and apoptosis.

Acne

The role of diet and acne has been theorized for some time. Acne is not found in cultures that still consume Paleolithic diets with minimal dairy products, milk, and hyperglycemic carbohydrates.[24]There is an association between acne and high intakes of dairy products in adolescents.[25]The physiologic mechanisms for the dietary correlation has been researched over the last several decades. Milk will increase the level of IGF-1 in the body, which can lead to acne through the synthesis of IGF-1 and androgen-mediated sebum production.[26]

Chocolate can worsen acne by increasing the likelihood of hyperglycemia and insulinemia.[26]One of the primary conductors of metabolism, the nutrient-sensitive and growth factor-sensitive kinase mTORC1, is overstimulated by a Western diet.[24,27]The mTORC1 kinase is found in sebaceous glands and lesional skin of acne patients and may serve as one of the mechanistic links between diet and acne.[24,28]

Psoriasis

A gluten-free diet is not always necessary for patients with psoriasis, although patients with psoriasis who have celiac-specific antibodies are likely to benefit from gluten-free diets.[29-31]Elimination diets may be helpful, but testing should be recommended prior to the initiation of that diet.[32]

There is a connection between psoriasis and metabolic disorders, such as diabetes and metabolic syndrome,[33-36]and diet and weight loss can have a positive impact on patients with psoriasis.[37,38]

Independent of obesity-related parameters, dietary intake of saturated fatty acids can greatly increase the pro-inflammatory stimuli in the skin, which in turn promotes the activation of keratinocytes in psoriasis.[39]

In conclusion, our diets can absolutely affect the health of our skin. Our diets are more than just consuming products for energy; a proper diet ensures we have the enough of the right nutrients to control our basic metabolic functions. The body is an intricate connection of organs and systems that work together as a miraculous, functional organism, and we must treat it as such for the organism to function at its highest capacity. Most of the research done has found what we would suspect; an unhealthy diet will have a negative impact on the health of our skin, and a healthy diet will positively affect our skin. Most healthy diets are centered around the concept of fruits and vegetables, with some meat or seafood, and very minimal processed foods and sugars. In short, healthy skin is obtained mostly from whole foods while minimizing processed foods.[32]

References available from WANP upon request.

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