Functional medicine is a patient-centered, science-based approach to healthcare that focuses on finding and addressing the root causes of chronic diseases, rather than just addressing their symptoms. This approach is increasingly popular for treating eczema, as it provides a comprehensive and holistic approach to managing this complex condition. Through the lens of functional medicine we look at the whole person, including their lifestyle, diet, and environment, to determine the factors contributing to their condition.
Common Causes
While the exact cause of eczema is unknown, researchers do know the immune system is undeniably involved. In my experience, I’ve seen eczema linked to food allergies, food sensitivities and gut health. There is also a large percentage of cases associated with FLG gene mutations. (across studies approximately 70% of eczema cases have a mutation in the Filaggrin gene)
Food Allergens
Food allergens which cause IgE mediated responses contribute to approximately 40% of eczema cases in infants. Many of these patients also develop allergic asthma and allergic rhinitis. This is called the atopic triad. The common link among these allergic disorders is the predisposition for IgE-mediated responses to stimuli.
Gut Health
Many studies have shown that eczema patients commonly have dysbiosis (unbalanced gut bacteria). Dysbiosis is a reaction to what we ingest as well as what gut bacteria we receive from our mothers during birth.
Infancy is where we see most eczema cases arising. This could be due to gut dysbiosis patterns passed down from birth.
One key aspect of a functional medicine approach to eczema is identifying and addressing dietary triggers. This may involve elimination diets or food sensitivity testing to identify specific foods that may be contributing to symptoms. In our clinic we may recommend a diet rich in anti-inflammatory foods, such as fatty fish, leafy greens, and colorful fruits and vegetables, to support the skin and reduce inflammation.
Stress management is also a critical component of a functional medicine approach to eczema. Chronic stress can trigger eczema flare-ups and worsen symptoms. Chronic stress is an immune modulator, it promotes TH2 dominance and impairs TH1 cells, this can disrupt the balance on the microbiome in the gut and have adverse effects on the microbiome of the skin, which promotes a vicious cycle of inflammation. It's important to address stress through practices such as mindfulness, deep breathing, and physical activity.
In addition to lifestyle modifications, we may also recommend targeted supplements and other therapies to support skin health and reduce inflammation. For example, probiotics, vitamins, minerals, and omega-3 fatty acids may be recommended to help restore balance to the gut microbiome and support skin health.
Especially in children, we may also focus more on addressing environmental triggers, such as harsh soaps, detergents, and chemical exposures, to reduce inflammation. Using gentle, non-toxic skin care products and avoiding harsh chemicals can help reduce symptoms.
Functional Testing
A unique part of our investigative approach is functional laboratory testing, which can often identify underlying imbalances that may be contributing to your condition.
A comprehensive stool test can give you insights into dysbiosis patterns (balance of gut bacteria), inflammatory markers, and zonulin (a key biomarker in detecting leaky gut). Many studies show a direct correlation that improving gut barrier function can improve skin barrier function.
A food allergy test can detect IgE-mediated responses to foods. Once identified, these foods should be removed entirely from the patient’s diet, lowering the total IgE response in the body.
Food sensitivity tests can detect IgG-mediated responses to foods that are causing inflammation in the body and should be removed and reintroduced later once the patient is no longer reactive to those foods. This process is called the Elimination Diet.
Omega fatty acid testing, omega 6 to omega 3 ratio such as omegaquant and Genova's NurtrEval. Many patients with eczema have imbalances in fatty acid metabolism. They will often have highly elevated omega 6 levels and inadequate omega 3 levels, with consequently high omega 6 to 3 ratios. The normal ratio should be 1:1 to 1:2, but with the introduction of grain based vegetable oils, many people in the western world have ratios as high as 10:1 and even 20:1. These omega 6 oils are highly inflammatory and exacerbate conditions such as asthma, eczema, rhinitis and sinusitis.
Finally, and on a personal note, I have suffered from seborrheic dermatitis since I was in my early twenties (20+ years), only when I made diet and lifestyle changes to deal with what I thought was a totally unrelated issue, did it improve. About six months into my food plan I realized that there was dramatic improvement, stubborn areas that itched for the past 2 decades, gone? It had just sneaked up on me and it was a truly pleasant surprise because it was completely unintentional, years ago I had give up on getting it to go away. Imagine going through a food plan to address a gut health and metabolic disease issue, and a 20+ year condition is 95% resolved as a side effect! This is the power of a functional medicine approach, many of us have been dealing with illness for so long that we forget what healthy looks like, what it feels like.
Dr. Reuben Simmons
Ivine Health Functional Medicine Clinic
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