305: Elimination Diets, Food Fear + Healing Skin Rashes {NEW RESEARCH}

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If you’ve ever tried eliminating foods to help your skin rashes, I want to share some newly published research on elimination diets + food fear.

This research is extremely eye-opening AND troubling simply because it tells us that there is a very significant + real risk of wrecking your relationship with food.

I’m not saying that improving the nutrient quality or diet diversity is a bad thing.

But elimination diets (regardless of health concerns) can be an extremely slippery slope to disordered eating or even eating disorders.

So let’s talk about how this happens and what the data tells us!

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In this episode:

• Why people try elimination diets for their skin
• The disturbing trend I see as a clinical nutritionist (working with skin problems)
• Most common thing people do first when they start to flare up
• Research on the incidence of food fear from elimination diets for chronic skin conditions
• What if you have a history of an eating disorder?
• When to ask for help so you don’t end up with an eating disorder

Links:

The Effects of Food Elimination Diets for Dermatological Conditions on Physical + Mental Health (POSTER)

Quotes:

Health problems can inspire substantial shifts in diet + lifestyle BUT, there’s a point where these changes can become counterproductive + even harmful.

I generally do NOT recommend eliminations for people with a history of an eating disorder unless they are working with a therapist trained in this area.

 

305: Elimination Diets, Food Fear + Healing Skin Rashes {NEW RESEARCH} (FULL TRANSCRIPT)

Welcome back to episode #305 of the Healthy Skin Show!

In today’s episode, I want to talk about the new research that shows the worrisome connection to food elimination diets used to help your skin.

So if you’ve ever thought about changing your diet or eliminating certain foods to see if it will help your eczema, psoriasis, acne, rosacea, dandruff, hives, etc., this is for you.

I know that there are thousands upon thousands of articles, posts, videos + other content online that discusses and even recommends various restrictive eating plans that may be called something like eczema diet or psoriasis diet.

Or could even appear if you search for phrases like trigger foods for acne, trigger foods for eczema or trigger foods for rosacea.

They all make grand promises of helping you identify your trigger foods, reduce inflammation and even heal your skin…

So long as you stay on your elimination diet + continue to avoid your trigger foods.

For some, the list of foods to avoid can be one or two foods while others end up with a really lengthy list of food triggers!

While I’m all for improving nutrient density + diet diversity as a licensed clinical nutritionist, new research confirms something I’ve worried about for quite some time.

That the use of elimination diets can backfire + deeply harm your relationship with food.

AND could make your skin rashes even worse!

So let’s talk about what’s going on here, where things with elimination diets can go sideways + what to do if you’re already struggling with a lot of food fear and your tendency is to restrict even more as soon as you feel a flare come on!

 

Why Elimination Diets Are Used To Help Skin Problems

Before we dive into the research, I think it’s important to set the stage because I very much understand wanting to make changes that could positively impact your health + your skin.

Especially if you feel like what your dermatologist is offering you isn’t working well enough or you’ve read enough online in different Facebook groups or books that’s convinced you enough to give this a try!

I was in the same boat as you years ago when I was trying to figure out my dyshidrotic hand eczema.

So yes, I see your good intentions + I want to commend you for going further than what you may have been asked to do to deal with whatever’s going on with your skin, be it eczema, psoriasis, rosacea, hives, dandruff, or even a combination of issues.

And I don’t want you to think that I’m against any diet changes (because I’m not).

I know first-hand that health problems can be an inspirational springboard to making substantial shifts in diet + lifestyle.

BUT, there’s a point where these changes can become counterproductive + even harmful.

Especially when fixation on diet pits you against what should be seen as nourishment.

This can drive a ton of food fear that leaves you blaming food at every turn.

The moment your skin flares up – “it must be something in my diet” so you restrict even more!

And this may seem harmless until you realize that you are more afraid of food than you enjoy it.

You aren’t sure which foods are safe and which might actually be a problem.

The idea of reintroducing certain foods actually makes you afraid of what could happen.

Before you know it, your good intentions that were guided by books, online forums + suggestions by other skin rash warriors, and even experts online can leave you in a bad spot.

 

Disturbing Diet Elimination + Food Trigger Skin Rash Trends

Just like my former client Judy (her name is changed to protect her identify).

She had been struggling with eczema for years without much help from medications that her doctor recommended.

For a couple years prior, she’d dove headfirst into a Google rabbit hole educating herself on the connections of diet, health and her skin problems.

I think she read most of the books for eczema in addition to everything on autoimmunity she could find.

She started with simple diet changes (like removing eggs, dairy + sugar) and then moved on to more extensive eliminations based on AIP (autoimmune protocol) because of a well-known functional medicine doctor’s book.

After noticing some improvements, she layered overtop another diet removing even more + more foods to the point where we finally started talking.

At this point, she’d whittled her diet down to five foods.

Yes, you heard me correctly – she was eating the same five foods every single day.

She thought that the more foods she removed, the less inflammation she would have in her body that would ultimately help her skin to heal.

Trying to get her to reintroduce foods was one of the hardest things to do – and I’m not talking about processed foods. Just things like blueberries or sweet potato.

In her mind, these things were possibly responsible for her skin flareups (though admittedly she wasn’t sure) and the idea of adding them back also may have meant skin flare ups.

I wish I could say that I was successful in helping Judy, but after a point, we couldn’t get on the same page and I felt she needed more help because at the point, we were way beyond food fear.

AND I wish I could say that this was my only encounter with someone with this experience of removing more + more food with the hope of healing their skin (and other symptoms).

But that’s not the case.

Judy’s story is way too common.

Which is why I do so much research + work focusing on other root causes because there are TOO MANY PEOPLE who are being driven to food fear or even an eating disorder in the skin rash community.

So yes, I understand the good intentions around diet, but you shouldn’t have to trade your relationship with food to save your skin or health.

 

Research On Elimination Diet For Rashes + Food Fear

Seeing this pattern happen again + again in my clinical practice as well as learning about others’ journeys in my online community led me to question how prevalent this elimination diet + subsequent food fear trend actually was.

So in October 2021, I spoke with Dr. Raja Sivamani about partnering with his research team at UC Davis to answer this exact question.

We developed a written questionnaire that ultimately was completed by over 600 people who had been diagnosed with a chronic skin condition.

The goal was to understand how frequently diet eliminations were being used as well as the impact that the diets had on the person’s relationship with food.

 

Here’s what we found…

 

 

Between acne, eczema, hidradenitis suppurativa, psoriasis + rosacea, approximately 80% of all respondents believe that you need to avoid certain foods for your skin to improve.

 

At least 70% of the respondents with these conditions had self-eliminated foods – meaning that they had chosen to do this on their own without being directed to do so from a practitioner.

 

 

In terms of age ranges, the 18-24 year old bracket is drastically more impacted with over 80% now having a negative association with food triggered by an elimination diet. The incidence lessens as respondents get older, but still clocks in at around 47% of those 55-64 year old who note that an elimination diet has triggered a negative association with food.

 

 

What was also highly disturbing is of those with a history of anorexia, bulimia + binge eating, over 60% responded that an elimination diet triggered a negative association with food!

And even if there was no history of eating disorder, more than 54% felt that an elimination diet triggered a negative association with food.

Honestly, even though I saw this trend happening on social media + in my practice, those numbers were shocking even to me.

The research team also told me that they were really surprised by the results.

Beyond the research that I was involved with, we also know that unnecessary food eliminations can trigger potential IgE allergic reactions in some individuals.

Dr. Peter Lio (a favorite Healthy Skin Show guest) has published at least one article that I know of warning about this specifically in atopic dermatitis patients.

I’ve unfortunately seen this happen to clients so keep this risk in mind when you eliminate foods based on what you read online or in a book, or even foods suggested by a practitioner – that developing an IgE allergic reaction to those foods is possible.

 

What If You Have Food Fear (Or Want To Avoid It)

I presented this research to a large group of functional + integrative nutrition professionals in October 2022 who also found the outcomes sobering.

No one was particularly surprised + many acknowledged that they had also noticed disturbing trends similar to my experience in their own communities.

While I’m very much onboard to “eat real food,” we cannot simply turn a blind eye to the potential damage that can happen to some.

Especially those with a past history of disordered eating patterns or an eating disorder.

Better evaluation of an eating disorder history must be done by nutrition AND health professionals (this include doctors) who recommend elimination diets.

I generally do NOT recommend eliminations for people with this type of history unless they are working with a therapist trained in this area.

And you as the ultimate participant of food eliminations also need to be cognizant of how elimination diets could be triggering for you (even if you feel that a disordered relationship with food is in the rearview mirror).

If you find yourself afraid to reintroduce foods or your knee-jerk reaction is to restrict any time your skin starts to flare – these are warning signs of food fear.

While I understand the logic, chronic skin problems are so much more than just a diet problem. I’ll keep repeating this over + over because people need to hear this!

So what are some guidelines that I think should be added to the conversation?

First of all, it’s best to avoid extensive elimination diets for longer than six weeks without starting reintroductions.

If you find that you’re reacting to many of the foods during reintroduction, that’s a clear sign that you need more help (not just to leave them out indefinitely).

But if you’re already struggling with food fear, the best recommendation I can suggest is to find a nutrition professional with a philosophy that meshes with your needs and/or a therapist trained to support you as you go through the fear of reintroduction.

Seek out other root causes beyond just food to help you address more foundational issues so that you’re not constantly blaming food for every symptom or flare.

And please be careful who you take diet advice from because practitioners do not all have the same training + skillset when it comes to more complex health and diet concerns.

Cleanses + detoxes or fasting to try to “starve” something in your gut or “reset your gut”… can all lead to a place that you didn’t intend to arrive at.

Because if you’re serious about being more integrative or functional, you can’t just ignore this.

The price to have healthier skin shouldn’t be your mental + emotional wellbeing when it comes to food.

It’s crucial to find a balance – not beget one problem for another one that will unfortunately follow you around even if your skin does end up healing.

And if you’ve found elimination diets helpful + didn’t struggle with food fear, I’m happy for you.

But I want to continually hold space for those who aren’t in that boat.

Because their experience is equally real + its my hope with this research, we can provide more nuance + care to the use of elimination diets in the future.

If you’ve got any questions or thoughts to share about this, leave a comment below so I can address them.

Thank you so much for tuning in and I look forward to digging deeper with you in the next episode!

 

REFERENCES

1. Effects of Food Elimination Diets for Dermatological Conditions on Physical & Mental Health {POSTER}. Thacker S, et al. October 2022. Integrative Dermatology Symposium.