Question: How Can Diet Affect the Skin?
Now that the holidays are over and our attention shifts from the food associated with festivities back to fitness and wellness, many recent queries have unsurprisingly been about the role of diet in skin health and aging. For example, many have asked about the role of sugar, dairy, and gluten in their diets and whether avoidance of these and other foods could help skin become clearer, less inflamed and age more slowly.
Frequently I am also asked about the role of dietary supplements – whether any claims among the many products advertised to improve the skin are backed by science, and if so which products are legitimately helpful, safe and pure (since the vitamin and dietary supplement industry is largely unregulated).
As I always say, while nothing on this site is meant to be taken as medical advice for any individual person, here is some general guidance to help one navigate the often conflicting information that is our there. Many have also asked what I do for my own skin health and if I take supplements, and so some of the links and resources below are simply an answer to those questions of what I take and what I do.
With over 50% of Americans using dietary supplements, and an estimated $30 billion a year spent on pills, supplements, special foods and weight loss programs, media and economic trends in the U.S. reflect a growing interest in dietary modification in the pursuit of health and improved appearance. (1) As a physician, I see this market place trend enter the exam room, and doctors are often asked to weigh in on the validity of claims made by the proponents of diets and supplements, and to help patients distinguish between the marketing claims made in the media and on supposed informational websites, and actual benefits supported by scientific data.
The challenge of being asked to evaluate and recommend products not regulated by the FDA is no small matter. New products are continually being introduced, and claims surrounding them can be difficult and time consuming to sort through. NIH recommendations are a useful resource for physicians who may not have the time to review product specific information and determine the efficacy of ingredients or the quality of the supplements themselves. They can also help distinguish between claims made by manufacturers and actual scientific evidence for the benefits of supplementation.
The benefits of some dietary supplements have been validated in reliable studies.
For example, supplementation of EPA-DHA Omega-3 fatty acids (such as in Fish Oil) has been shown to be of benefit in prevention of heart disease, as an adjunctive therapy in inflammatory disorders (including some skin diseases), as well as for cognitive function and emotional health.
Here’s the fish oil supplement that I take almost every day:
The recommended daily dose of Fish Oil for most adults is 1-2g/day and can be taken in the form of oral supplements or by consuming at least 3.5 ounces of food sources high in Omega-3 fatty acids such as fish like salmon or mackerel. (2,3).
There is also a potential value of probiotic supplementation, which has been recommended in dietetic circles for decades, and has recently come to be accepted in mainstream medical practice for prevention of antibiotic related gastrointestinal (digestive) complications. Research into the role of the microbiome in the modulation of
certain diseases has also made the topic of probiotics relevant for multiple conditions from Cystic Fibrosis to mood disorders, and with respect to dermatology, the impact on disease severity in the allergy and hypersensitivity
family of disorders such as asthma and eczema are being increasingly explored. It is importof ant however to read the microbial profile of a given probiotic supplement before recommending or endorsing it, as among the many products that tout themselves as probiotics only certain strains of beneficial bacteria have been studied with
respect to the advertised benefits of probiotics. Thus the NIH recommendations regarding the prescribing of probiotics for various conditions and for distinguishing between different brands and strengths can be a useful
resource for clinicians are available online. (4)
(This is an example of a probiotic supplement I researched and found to be a good product: https://store.doctoremi.com/products/maximum-probiotic)
The question of Vitamin D supplementation, and the sources and extent to which it should supplemented, have also emerged as issues of media attention and confusion, and for these, likewise guidelines from the American Academy of Dermatology an the NIH found online can be useful. These recommendations include that a person obtain vitamin D from dietary sources which are more reliable and safer than UV exposure, and good sources include: fish, eggs, diary products, fortified cereals, and vitamin D supplements (600 – 800 International Units per day for adults and 400 IU/day for children is recommended by the National Institutes of Health (http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/).
(These are chewable vitamins that I take from a line that I researched and found to be very good quality and which actually tastes really good and contain the recommended amount of Vitamin D:
Regarding dietary recommendations, most experts in diet and health advise eating fresh unprocessed foods as often as possible.
Meanwhile an important principle of diet based intervention remains that interventions must be personalized. One size does not fit all. For example, while the “paleo” diet may be beneficial for many, for some patients (e.g. with renal insufficiency) the emphasis on animal protein consumption may not be helpful, and in the case of pediatric or adolescent patients, it may not be advisable to limit their diet so rigidly as to eliminate all grains and legumes. To that end, many doctors recommend focusing on limiting the one dietary factor that one feels will have the greatest impact and may be most feasible.
For example one may consider limiting gluten intake the case of psoriasis.
Others consider eliminating dairy products to assist in the control of moderate to severe acne.
Some patients who suspect ingested causes of dermatitis may consider tailored elimination diets (e.g. eliminating one variable at a time for certain periods) to identify possible triggers. (5)
As with any medical recommendations we provide to our patients, in the realm of supplements and dietary modification, we must hold to same principles of moderation, evidence based practice, and the specific needs of each patient.
- Michaëlsson G1, Gerdén B, Hagforsen E, Nilsson B, Pihl-Lundin I, Kraaz W, Hjelmquist G, Lööf L. Psoriasis patients with antibodies to gliadin can be improved by a gluten-free diet. Br J Dermatol. 2000 Jan;142(1):44-51.