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What Does Your Gut Have to Do With Eczema? A Lot...
It may seem odd to discover that eczema, a skin disease, is largely controlled by the state of your gut but a lot of studies have confirmed this fact. The gastrointestinal tract is directly married to the immune system and is responsible for keeping out foreign substances from the bloodstream. We now know that the gut is connected to the skin through the immune system but exactly how does this relationship work? How does gut flora affect skin health and what benefits do probiotics have in the treatment of eczema? This article answers all your questions about the link between the bacteria living in your gut and your itchy skin.
by Brad Chase
Eczema or atopic dermatitis is a term used to describe a broad selection of skin conditions. It is characterized by dry skin, rashes, itching, swelling, redness, flaking, crusting, blistering, oozing of pus, bleeding, discoloration and repeated eruption of skin sores.
Although there are many types of eczema, the one with a direct link to gut flora and diet is known as atopic eczema.
Atopic eczema is a chronic skin condition and an allergic disease with genetic components. It is also hereditary and known to occur along with other allergic diseases such as asthma, hay fever and food allergy.
Atopic eczema is commonly confused with contact dermatitis, a different kind of eczema. However, it is not triggered by skin contact with irritants. In addition, clinical data show that the prevalence of atopic eczema is on the rise in developed countries.
The exact cause of eczema is unknown but experts believe that it is triggered by a combination of genetic and environmental factors.
In addition, there is solid evidence to link eczema with gastrointestinal diseases involving food intolerance. In fact, eczema is also commonly diagnosed in people with celiac disease.
Studies show people who suffer from celiac disease are three times more likely to be diagnosed with eczema than the general population. In addition, relatives of celiac disease patients are two times more likely to develop eczema.
A 2010 study published in the Journal of Allergy and Clinical Immunology shed a new light on the development of eczema with regards to the damage done to the skin.
While previous studies identified that the outermost layer of the skin is more porous than usual in people with eczema, this new study found that the increased permeability of the skin extends even deeper.
Ideally, the stratum corneum (the outer layer of the skin) serves as a physical barrier to keep off irritants, allergens, toxins and microbes from reaching the lower layers of the skin. However, this barrier is leaky in people with eczema.
The discovery of a second leaky layer is even more proof that the structural damage in eczema is not restricted to the surface of the skin.
This second layer consists of tightly grouped cells. However, in people with eczema, these cells are not tightly packed and the gaps between the junctions they form are wide enough to allow the passage of foreign substances.
The researchers also found that the level of a tight junction protein known as claudin-1 is significantly reduced in the skin of eczema patient.
Therefore, they recommended that new eczema treatment options targeting leaky skin should be developed. The researchers believed that such treatment will produce better results than the anti-inflammatory topical steroids commonly given to eczema patients.
However, the skin is not the only leaky organ in eczema, there is strong clinical evidence to show that leaky gut can also contribute to eczema.
Leaky gut syndrome is also called intestinal permeability. Like leaky skin, leaky gut refers to increased permeability of the gastrointestinal tract.
Ideally, only the small molecules of digested foods and micronutrients can pass through the linings of the gut into the bloodstream. However, when the gut mucosa is destroyed by inflammation and microbial action, it allows the passage of undigested foods, toxins and pathogenic microbes into systemic circulation.
These foreign substances are transported to different parts of the body and along the way they cause damage to various organs such as the skin.
The immune system reacts to the presence of these foreign substances by releasing proinflammatory cytokines. Therefore, leaky gut can cause eczema by allowing harmful substances to reach the skin and by also increasing inflammation in the deep layers of the skin.
But what triggers leaky gut? The destruction of the normal gut flora and the invasion of the gut by pathogenic microbes.
The normal gut flora is mostly made up of beneficial microbes that help keep pathogenic microbes in check as well as fulfil metabolic and regulatory functions.
However, when the normal flora is destroyed (by disease, diet or drugs), the pathogenic microbes quickly colonize the gut and change the state of the gastrointestinal mucosa. This reversal of the gut microbial population is responsible for inflammatory bowel diseases such as Crohn’s disease.
When these pathogens damage the lining of the gastrointestinal tract, they spread into the bloodstream and may cause diseases far from the site (gut) of breach.
Eczema is one such disease triggered by the destruction of the healthy gut flora.
Before pathogenic microbes fully invade the gut, studies show that the composition of the gut flora can be used to accurately predict the risk of eczema.
In a study published in the journal, Gut, in 2007, researchers found out that a healthy and balanced gut flora established early in life can protect against chronic medical conditions such as asthma, allergies and eczema.
In a landmark study published in the journal, BioMed Central Microbiology in 2003, another group of researchers discovered that the bacterial content of the guts of infants who will develop eczema was markedly different from those who will not after 18 months.
The study found that children with high risk of eczema had gut flora that closely resembled the gut flora of adults.
Specifically, the researchers found that that infants who developed eczema had a predominance of bacteria from the Clostridium family.
In sharp contrast, the kids who did not develop eczema had higher proportion of Bacterioides bacteria.
This bacterial family is the predominant microbe in the gut flora of people whose diets contain a lot more proteins than carbs.
To highlight the importance of the right diet to the development of eczema, the researchers found out that the infants who were most likely to develop eczema were also the ones who were breastfed for the shortest periods of time.
However, the contribution of diet to eczema extends well beyond infancy.
There is solid clinical evidence to show that diet plays an important part in eczema. In fact, certain food allergies and atopic eczema share common components.
Just as some foods can trigger eczema and leaky gut syndrome, others can heal the gut and relieve eczema.
To overcome eczema, some health experts recommend adopting special diets. One of this is known as GAPS diet.
GAPS or Gut and Psychology Syndrome is a condition believed to be responsible for certain chronic psychological and physical conditions such as autism, dyslexia, ADHD (attention deficit hyperactivity disorder), depression, obsessive-compulsive disorder, bipolar disorder and schizophrenia.
The proponents of GAPS believe that the state of the gut is the root of many neurological and psychological conditions. Therefore, the right choice of food can help reverse the damage done and heal these conditions. And there is some scientific support for this theory.
The GAPS diet is a modern variant of the Specific Carbohydrate Diet (SCD) and it was created by Dr. Natasha Campbell-McBride.
GAPS diet is designed to help address psychological problems and digestive disorders.
Eczema is one of the conditions for which GAPS diet is recommended. It is listed as a presentation of imbalance in gut flora that can be corrected with the diet.
The most solid evidence for the role of gut flora in the development of eczema comes from studies investigating the difference between the gut microflora of infants who develop eczema and those who did not.
In one 2008 study published in the journal, Clinical and Molecular Allergy, the researchers compared the microbial diversity in 21 infants by taking fecal samples at 1 month and 4 months after birth.
Out of these infants, 9 developed eczema by the 6th month while the rest served as controls.
The results of the study showed that even by the first month, the infants who did not develop eczema already had greater fecal microbial diversity than those who did develop eczema. This diversity between the two groups only widened by the 4th month.
Therefore, the researchers concluded that reduced gut microbial diversity is a risk factor for developing eczema early in life.
Another 2008 study published in the Journal of Allergy and Clinical Immunology also reached the same conclusion.
This study involved 35 infants and fecal samples were collected from the first week of birth but the researchers waited 18 months to determine whether microbial diversity was strongly linked with atopic eczema.
A 2012 study published in the above-named journal also concluded that the early state of gut flora can determine the risk of eczema. This study, however, expanded on the results of the studies described above.
For this study, the researchers recruited 20 infants with IgE-associated eczema and another 20 infants who had not been diagnosed with eczema at 2 years of age. By taking stool samples at 1 week, 1 month and 1 year after birth, the researchers discovered that
The researchers concluded that the gut microbial diversity in the first month of life can be used to predict the development of atopic eczema later in life.
A similar study was published in 2006 in the journal, Clinical and Experimental Allergy. By using molecular fingerprinting techniques, the researchers were able to determine that the predominance of Escherichia coli in the gut of a 1-month old infant was strongly linked to the development of atopic eczema.
A cohort (KOALA) study published in the journal, Gut, in 2007 also confirmed that E. coli was strongly associated with eczema but also found that Clostridium difficile was linked to atopic eczema.
Probiotics are commonly recommended for treating atopic eczema but how effective are they?
In a 2009 study published in the journal, Pediatric Allergy and Immunology, the researchers investigated the possible benefits of probiotics for preventing eczema in children weaned off breastfeeding.
For the study, the researchers fed 89 infants with cereals and the probiotic, Lactobacillus F19, from 4 – 13 months of age. To serve as control, they fed 90 other infants with only cereals for the same period of time.
After the 13th month, 11% of the infants in the probiotics group developed eczema while 22% of the control group was diagnosed with the skin disease.
The researchers concluded that feeding weaned infants with probiotics can reduce the risk of developing eczema. They believed that Lactobacillus F19 was effective for preventing the eczema because it enhanced T cell-mediated immune response.
A 2000 study published in the journal, Clinical and Experimental Allergy, also provided support for recommending probiotics to weaned infants.
The researchers recruited 27 infants who were diagnosed with atopic eczema during breastfeeding.
For this study, these infants were weaned to hydrolyzed whey formulas. A third of them got the formula supplemented with probiotic, Lactobacillus GG; another third got the same formula but with the probiotics, Bifidobacterium lactis; and the rest got the whey formula with no probiotics
The results of the study showed that the two groups who were given probiotics improved significantly after 2 months while the infants who were fed only whey formula barely improved.
A 2007 study published in The Journal of Allergy and Clinical Immunology investigated the benefits of probiotic mixtures along with prebiotics for reducing the risk of eczema in infants.
The researchers gave 1,223 pregnant women a mixture of 4 probiotic strains or placebo 2 – 4 weeks before delivery. Then the researchers gave the same probiotic mixture and the prebiotic, galacto-oligosaccharides, or placebo to their infants for 6 months.
At 2 years, the researchers evaluated the benefit of the probiotic-prebiotic combination on the development of 4 allergic diseases (eczema, asthma, food allergy and allergic rhinitis).
The results showed that the probiotic-prebiotic mixture was only effective (and very effective) for reducing the risk of eczema (and especially atopic eczema) and not the other allergic diseases.
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