If you Google “what causes eczema?” the typical answers describe an inflammatory skin condition, genetic in origin, primarily related to an abnormality in the skin. The answers seem to suggest that since it is genetic we are unable to change the root cause of the problem. Most people think of eczema as an isolated skin condition since it has an obvious presence on the skin. I want to squash these notions right here and now. Eczema (AKA atopic dermatitis) is a systemic condition that starts in our guts and is the result of a runaway immune system.
Our bodies can only tolerate a given amount of inflammation, and once we exceed that threshold, we will see signs of the problem. We often see those sign on the skin, as our skin is a window into our immune system. Although our guts are typically the major source of systemic inflammation, other factors such as stress, environment, household toxins, and topical creams and lotions are also contributing to our overall inflammatory level.
Holistically managing eczema means addressing all these areas to reduce our overall inflammatory load. We will begin with the gut as this is the single largest factor influencing our immune system. Remember, two-thirds of our immune system resides in our guts. So you need to start thinking of eczema as an inside out problem. Once we understand how the problem starts in our gut, we can then make the internal changes needed to heal our skin from the inside out. What gives me the right to make that statement? I have successfully treated thousands of eczema patients by healing their guts.
You Are Not Alone
If you or your child is suffering from eczema take solace in the notion that you are not alone. Incidence of eczema has increased 2- to 3-fold in industrialized nations since the 1970s, with approximately 15% to 20% of children and 1% to 3% of adults affected worldwide. Population-based studies in the United States suggest that prevalence is about 10.7% for children and 7.2% for adults. Non-hispanic black children are disproportionately affected with nearly 1 in 5 kids developing the disease.
Onset of disease commonly presents by 5 years of age, with the highest incidence occurring between the ages of 3 and 6 months, but it can occur at any age. Approximately 60% of patients develop disease in the first year of life and 90% within the first 5 years of life. 20% of children who develop eczema before 2 years of age will have persisting symptoms of disease well into adulthood (and this number is likely even higher).
If you live in the United States you are disproportionately affected by eczema. Children born outside of the USA have a 50% less chance of developing eczema but that risk increases to match American born kids after 10 years. Additionally kids in urban areas are more commonly affected than their more rural counterparts. And the disease does not differentiate by wealth – in fact children of parents with greater than high school education are also more commonly affected. For reasons I will discuss later, the US is an eczema producing machine!
Ok – so now that I have bored you to death with numbers let talk about something a bit more exciting – eating and pooping. To understand how eczema starts from the inside we need to understand a bit about human nutrition. Human nutrition is broken down into five basic stages.
Ingestion starts the process and begins as we place food into our mouths. As we begin to chew our salivary glands produce saliva to help soften and chew our food. Our taste buds are activated to appreciate flavors and the palatability of the food. This is where the American diet first starts to wreak havoc on us. The food industry has introduced chemicals into our food which put our taste buds into a state of bliss that nature has a tough time competing with. Food scientists have figured out how to create these chemical compounds which our taste buds simply can’t resist. There’s a reason that those first few bites of McDonalds or Doritos taste so darn wonderful. (If you are struggling with a picky eater read this blog post from Seven Layer Charlotte)
As the food passes down the esophagus and into the stomach and intestines the digestion process begins. As the food is turned and churned in our bellies, the larger molecules are broken down into smaller molecules. Our cells understand a simple language I like to call the fruit and vegetable language. This language consists of familiar words like potassium, calcium, magnesium and other nutrients found in those foods. However, when the body encounters strange new chemicals that have been added in a lab, our cells are confused. They struggle to decipher food additives like monosodium glutamate or disodium-5′-inosinate. In addition, our bodies consider some of these substances as foreign invaders, and start an inflammatory reaction to fight the invaders. Gluten and dairy are two common culprits that push the body into defense mode.
I want to take a minute here and point out the fact that it is ridiculous we place something called a “nutrition label” and many of the foods we eat. You are implying that there is nutritional value in many foods which are simply garbage. Many of us are taught in school how to read aspects of food labels such as fiber, fat or sugar but few of us are educated on the actual ingredient list. Thus we are bombarding our digestive system with loads of crap that the food industry has convinced us is “a nutritious part of our daily breakfast”!
The food we eat provides the fuel for our body to make the cells which sustain us. New skin cells are produced every 30 days, lung cells every 8 days, and gastrointestinal cells approximately every two days. To build these cells, our bodies require the vital nutrients that are found in fruits and vegetables. When we give our children breakfast cereal for example, we are supplying their cells with things like rice flour, canola oil, maltodextrin, trisodium phosphate, caramel color, and tertiary butylhydroquinone. Some of these chemicals are actually known to damage the gut and lead to inflammatory reactions and food allergies.
This brings us to the next step in the human nutrition cycle: absorption. As this slimy mass of squishy food particles enters our small intestine, the body is carefully evaluating and trying to break down each substance into something small and safe to enter our bloodstream. A whole team of specialized cells line up like soldiers along our intestines to guard this process. These guards are known as enterocytes and in a healthy gut they look like the fella on the left in the figure below. However, if they have been bombarded by enemy chemicals and molecules, they start to look like the guy on the right.
And just like a military defense, once the weak soldier can’t hold his ground, the wall is breached and the enemy enters allied territory. As this process progresses, the entire gut can become “leaky” as more holes are breached through fallen soldier cells.
The little guys above also like an acidic environment to work which is one of the reasons the use of antacid reflux medications increase the risk of eczema. The acidity also helps the body break down food. When we disrupt the normal acidic environment, our cells can’t manage the molecules and leads to a leaky gut.
Steroids and antibiotics also result in a similar damage to cells which leads to a permeable or leaky barrier between our intestinal lining and our blood stream (See my post on B. Infantis Gut Bacteria for More Info). This results in large chemicals and molecules leaking into our bloodstream that the body sees as foreign and potentially dangerous. (Excess sugar, also common in the American diet, leads to additional inflammatory molecules roaming our blood. Gluten and several other food proteins can also incite this inflammatory response.) An intense inflammatory reaction occurs which is our body’s way of mounting a defensive attack against invaders.
This inflammatory response is system wide. And guess where a large number of inflammatory cells reside? Yep, in our skin. They lie in wait in our skin to protect against skin invasion, but get mobilized to help out due to the attack in our bellies. The red itchy burning skin is simply the immune system performing like it should against the attack – except we as Americans have become ignorant to the fact that the attacking army is in our food. Yes, the processed food and excess sugar are the proverbial trojan horse.