Vegetarian diets
Welcome back! Lets continue our exploration of management of atopic dermatitis with looks into vegetarian diets and prebiotics/probiotics. The picture above is one of my most memorable forms of probiotics: Yakult. In terms of the vegetarian diets there really was not much to find from a research level but there were some abstracts that can help guide the conversation. I will premise saying that strictly going vegetarian should be followed by a registered dietician to make sure that certain micronutrients are retained through your nutritional input.
One of the abstracts used a SCORAD index to gauge the severity of atopic dermatitis symptoms through a vegetarian diet. The problem with this abstract is there was not a large amount of population being tested and they were individuals whose symptoms were not controlled with traditional remedies (such as topical steroids). It did look into adult patients and the pathology behind the SCORAD was a reduction in inflammation (via eosinophils, neutrophils, and PGE2). Eosinophils are what was described in the previous section as part of the type I hypersensitivity. PGE2 is released by inflammation and is one of the elements inhibited by the use of NSAIDs (ibuprofen/Advil, Tylenol, aspirin). Read more about this abstract here.
The SCORAD stands for scoring atopic dermatitis that looks at the extent and intensity of the lesions. Another abstract described this as decreased secondary to a vegetarian diet, kind of. They classified the diets tested here as undernutrition without malnutrition which basically means remaining in a caloric deficit while having micronutrient needs met. They noted that the diet caused a decrease in body weight and inflammation which led to a reduction in AD symptoms. There was a low amount of people in this abstract (14 females and 5 males) which limits its usefulness but it does touch on aspects we have mentioned previously. Read this abstract here.
I would also like to point out that there are multiple types of vegetarian diets. There is lacto-, ovo-, pesci-vegetarian to name a few. One interesting correlation found in an abstract shows that a three month regimen of a lacto-ovo-vegetarian diet provided benefits of increased IgA (your gut immune globulin that is protective) and a decreased in IgE expression as an indirect based on the gut microbiome change. Although not directly influencing the symptoms of atopic dermatitis, it is good to note when trying this diet out and seeing how it effects your personally. Read about this abstract here.
With this said lets go ahead and jump into our next section.
Prebiotics and probiotics
Let’s start off with providing the difference between the two. Prebiotics is food for the healthy gut bacteria and probiotics is actual good gut bacteria. So, when you ingest probiotics, you are ingesting live strains of the good gut bacteria that help your digestive tract. So, when can you start using probiotics to start developing good gut microbiota? Anytime.
One study reviewed many papers to find that probiotics may protect neonates (in both pre- and post- periods). An interesting thing about neonates is that their microbiome isn’t really established until within the first year of life and is unique to the mother’s microbiome. Establishing a healthy scaffold to grow from is the direction of meaning this paper was getting at. Read more about this here. Other articles I saw were abstracts that emphasized a benefit to infants receiving probiotics for protection from atopic dermatitis/eczema. Then the question is what about the other populations?
The only other paper I could find was an abstract that basically said there’s more to learn about the microbiome and although it can help, we just don’t know enough yet. Unfortunately, that’s just how it goes sometimes with directions for research. Here’s the abstract for this here. There was even a research paper that went into many mechanisms and reasons why it would help but did not make a legitimate statement that if you do this good things will happen for your atopic dermatitis symptoms. Here is the research paper if you want to learn more.
So how can we use this information? One of the oaths we take when getting into medical school is the hypocritic oath which has the famous line of doing no harm. With that said I can’t confidently recommend when you implement prebiotics and probiotics that your symptoms will change. That being said, the research is there that checks lots of boxes and could still be a staple in providing for a healthy nutritional gut microbiome. There are plenty of research out there boasting the benefit of health of microbiome and great health outcomes. Heck, this is the go-to for some people with C. diff after antibiotics won’t help anymore.
With anything make sure to seek regular checkups with your physician and registered dietician to make sure that you are hitting all the marks when starting a drastic transformation in adjusting your nutritional needs. This is very particular for implementing vegetarian diets. Have you or someone you know tried these tricks out and it helped or hurt them? Again, these are seen here as ways nutrition can help with atopic dermatitis but are also a good wedge into building the knowledge of build healthy habits in eating.
The Yco-system 