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Dietary Manipulations That Resolve Atopic Dermatitis
- Joseph M Mercola (7 June 2002)
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Nature vs. nuture - Beyond genetic risk transmission
- Johannes Reich (13 June 2002)
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phototherapy in atopic eczema
- Margaret.L Wood (18 June 2002)
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"Atopic" Dermatitis- The Food Connection
- John B. Symes, Mobile, AL 36609 (22 June 2002)
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Re: "Atopic" Dermatitis- The Food Connection
- Michael L McCann (25 July 2002)
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Joseph M Mercola, Medical Director Optimal Wellness Center Schaumburg, IL 60194
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Over the last 15 years our center has routinely provided resolution of severe cases of atopic dermatitis with inexpensive nutritional manipulations that are not covered in this review. These dietary changes have had profound beneficial effects in the most extreme cases of atopic dermatitis we have seen. The key is balancing the omega 6:3 fat ratio. The first step is a severe limitation of n-6 fats that are converted to inflammatory archidonic acid lipoxygenase mediators. N-6 fats are common in nearly all polyunsaturated vegetable oil products (with the exclusion of olive and canola oils, which are relatively high in n-9 and n-3 fats respectively). Bakery products are particularly troublesome, as high percentages of the n-6 fats have been converted to trans isomers that further exacerbate the dermatitis. The second step would be to increase elongated n-3 fats, such as EPA and DHA that are common in fish oils. Cod liver oil is profoundly effective here as it has significant quantities of vitamin D and vitamin A that frequently provide synergistic therapeutic effects. Typical daily therapeutic quantities of n-3 fats are 300 mg per 4 kg of body weight. Supplementation with the shorter chain n-3 fat, ALA (i.e. flax) is frequently not sufficient to generate significant quantities of beneficial eicosanoids as only 10% of ALA is elongated and desaturated to the higher chain n-3 fats, EPA and DHA. If the child is breast-fed these dietary manipulations are, of course, initiated through the nursing mother. If the child is eating table foods two additional manipulations are most useful. The first is to limit most grains and fruit juices as they are rapidly converted to simple carbohydrates that increase insulin levels. The increased insulin levels inhibit delta-6 desaturase, which converts linoleic acid to gamma-linolenic acid (GLA). The elevated insulin levels also facilitate delta-5 desaturase, which further increases pro- inflammatory by products of arachidonic acid. Although GLA is an n-6 fat, we frequently find supplements of 2-3 gram quantities GLA from evening primrose oil beneficial in compensating for the impaired delta-6 desaturase activity. Additionally, restriction of all gluten and casein containing foods and regular exposure to sun provide additional valuable measures in healing this challenging problem. Mayser P, Mayer K, Mahloudjian M, A double-blind, randomized, placebo -controlled trial of n-3 versus n-6 fatty acid-based lipid infusion in atopic dermatitis. JPEN J Parenter Enteral Nutr. 2002 May-Jun;26(3):151-8. Reynolds, NJ, et. al. Narrow-band ultraviolet B and broad-band ultraviolet A phototherapy in adult atopic eczema: a randomised controlled trial. Lancet June 23, 2001; 357: 2012-16 Solvoll K, Soyland E, Sandstad B, Dietary habits among patients with atopic dermatitis. Eur J Clin Nutr. 2000 Feb;54(2):93-7. Yu G, Bjorksten B. Polyunsaturated fatty acids in school children in relation to allergy and serum IgE levels. Pediatr Allergy Immunol. 1998 Aug;9(3):133-8. |
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Johannes Reich
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The authors state "There is clearly also an important hereditary component to atopic eczema. This is complex because not all affected children are atopic, though the genes implicated in atopy are likely to be involved, together with others as yet unknown." I missed the thought, that there possibly is a strong component transfered from mother to child that is not of genetic nature. The facts are: 1. Atopic dermatitis primarily is a disorder of the immune system. 2. The immune system develops in interaction with the individuals environment. 3. The child's first and most important environment is its mother. It comes therefore to no surprise that for example breast feeding significantly lowers the risk of acquiring allergic immune responses later in life. 4. The increase in allergic diseases is much too rapid to be accounted for by a genetic change in our population. These four points suggest, that the transferral of risk to acquire an allergic disease later in live is substantially modified by the immune status of the mother. If her immune system already reacts allergic, it could well be that the maturation of the child's immune system - reacting totally normally, i.e. with no special genetic mutations - is driven in the same aberrant direction. As a consequence it would be more rewarding to look at the reaction of a normal, maturing immune system to an allergic maternal environment than to a maturing allergic immune system reacting to a normal maternal environment. With kind regards, Johannes Reich |
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Margaret.L Wood, consultant dermatologist rotherham general hospital S60 2UD
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Editor - I wish to draw attention to what I feel is a significant omission on the part of Barnetson, Rogers et al., ( BMJ vol 324, 8. June 2002), in the management of atopic eczema in children. Phototherapy in various forms ( UVA, UVB and PUVA) is well known to be of benefit (1, 2 ) and though more frequently used in adults, is an important option in severe disease. Though long term risks, ie., skin cancer may be a possibility with repeated / chronic use, this is a risk that I personally would far rather take than those associated with systemic immunosuppression, whether chronic or intermittent ( ciclosporin/ azathioprine). (1) Jekler J., Larko O. UVB phototherapy of atopic dermatitis. Br. J. Dermatol. 1988; 119: 697-705 (2)Atherton D.J., Carabott F., Glover M.T. et al., The role of psoralen photochemotherapy (PUVA) in the treatment of severe atopic ezema in adolescence. Br. Med.J. 1988;118:791-5 Margaret Wood, consultant dermatologist
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John B. Symes Beltline Animal Hospital, Mobile, AL 36609
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I have been a practicing veterinarian for 23 years. I found out 2 years ago, that I have had celiac disease all of my life. The discovery of this often times insidious condition has been an absolute blessing, both personally and professionally. I had no idea that wheat could be such a serious threat to our (and our pets) health. But, since I have been off wheat (and subsequently dairy, soy, and most other grains), I am a completely different creature. GONE are my allergies, heartburn, irritable bowel, headaches, insomnia, and fibromyalgia of years and years duration. It was truly miraculous, but in retrospect completely understandable. This got my attention as a professional, a scientist, and as a patient. But it boils down to this- this country has to stop eating the FDAs top childhood food allergens. Cow milk is number one and wheat is number two...soy is number four. 60-70% of the American diet is made up of the dairy and wheat alone. Celiacs (gluten intolerance) and casein intolerants have staggering rates of eczemas. Most of my patient's allergies have resolved with strict elimination of these foods...cured. |
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Michael L McCann, retired pediatric allergist Kaiser/Cleveland Clinic
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Concerning food connection and eczema, I would like to offer my experience as a pediatrician and allerist while working at Kaiser/Cleveland Clinic for past 10 years. Because of our pre-pay set up I was able to routinely skin test all patients referred for eczema, both children and adults. Contrary to current medical opinion, I found a high corellation with positive skin prick tests and foods. (Multitest). The use of quantitative readings and purified antigens has allowed this reevaluation of the reliability of skin testing, formerly very unreliable because it was not quantitated. That is "positive" vs "negative" prick skin tests are meaningless unless carefully quantitated by comparison to a positive histamine and negatve saline control test done simultaneously. When this is done there is a high degree of correlation between postive skin tests and clinical eczema in all ages, up to 90 % of very young and diminishing in older patients. Therefore the major mechanism is simply an IgE reaction to food antigens, especially in infants and very young children, with additional contact allergens, in particular the 2 house dust mites as the patient ages. Treatment should be limited to removal of only the positive tests and not general foods such as milk and wheat (excepting Sprue which is diagnosed not by an IgE antibody but rather and IgG antibody specific for gliadin) or if the skin test is positive. In cases where there are so many positive foods that removal may result in a nutritional deficiency or a diet so restrictive so as not to be practical, it is only necessary to remove the most positive reacting foods and to supplement the diet with pancreatic oral enzymes with each meal. This is the same principle as feeding hydrolyzed milk formulas like Nutramigen or Alimentum to patients with milk allergy. You are simply hydrolyzing all the protein foods in the stomach before they can get to the small bowel to be absorbed as allergens, converting the allergenic sized proteins to the less allergenic amino acids and smaller peptides, and doing it in the stomach rather than predigested commercial cannd products. Dose is 1 to 4 capsules containing 25,000 USP U/cap of pancreatin and there are several companies selling it and some non-prescription OTC. There are essentially no side effects and the method works not only for eczema but also in many other symptoms cause by unsuspected food allergis such as hives, diarrhea, headache etc. I have had such universal good results with this approach that it is hard to believe it is not yet standard practice. It is entirely safe, has no side effects, relatively inexpensive, allows a regular diet with few restrictions (peanut is an exception) and it uniformly works. Not that the nutritional effects of essental fatty acids are not important, but far less important than identifying the offending food allergens and not advising patients to eat u |
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