Eczema & the Gut Microbiome

13 Mar

You might not automatically think of your gut health when you are experiencing an eczema flare up, but in many cases this could be the key to lasting relief. A triangular relationship exists between the digestive system, the immune system and the health of our skin. In fact when it comes to our health, everything is connected, which is why the root cause of our symptoms is often far from obvious.

Eczema affects 1 in 5 children in the UK

If you live in the UK, the chances are that you know a child affected by eczema. My first experience of eczema was with my second child, who developed it as a newborn baby. It started on his face and was particularly bad across his forehead. By around 10 months, although his face was clear, the eczema had become more severe and now covered his entire body. It caused him (and us) a lot of distress, especially when it was exposed to air. We would constantly slather him in emolients and cover his body with long sleeves and trousers - and always socks! Getting ready for work and nursery was a nightmare. He cried whenever we applied his creams and just wanted us to cuddle him. But we were desperately trying to keep the greasy creams away from our work clothes - this was pre-covid when every day was an office day!

We put him in oat baths, used sensitive laundry detergents, removed potential allergens from his diet, but nothing helped other than prescribed steroid creams and lots of moisturiser.

Then something strange happened…it disappeared! By age 3 there was no sign of his eczema and no miracle cure to give credit to. He had no food allergies or other atopic conditions (e.g. asthma and hayfever which often co-exist and run in families).

What happened?

We actually didn’t question what had happened in those first few years of his life, or what had changed to improve it. We were just happy to carry on with our busy lives, relieved that we no longer had the stressful moisturising and screaming ritual to deal with twice a day.

But fast forward 2 years to my nutrition training. I was writing an assignment on Atopic Dermatitis (the most common type of eczema) and was surprised to learn that our experience was very common. In the UK, onset of baby eczema occurs before 6 months in around 45% of cases. And 95% of these cases will resolve during childhood. As I learned about the pathophysiology of the condition, I started to understand what may have occured in Bodhi’s case, where there was no family history or co-existing atopic conditions.

In my research, I came across a 2013 study published in the British Journal of Dermatology. The researchers had uncovered a link between eczema and antibiotic use in the first year of life. In fact, they found it to increase the risk of developing eczema by 40%. This was my lightbulb moment! Bodhi had been born with some minor complications which required him to be in special care for the first few days of his life, where he received intravenous preventative antibiotics. The study had suggested that the impact of antibiotics on the gut microbiome potentially alters the developing immune system, promoting allergic hypersensitivity in the infant. This was all making so much sense about what had happened to our son.

I have no regrets about the treatment Bodhi was given. Those antibiotics could have potentially saved his life and, for many newborn infants, antibiotics are essential and life saving. But I am surprised that none of the doctors or healthcare professionals who saw Bodhi for his eczema ever mentioned this link or suggested supporting his gut microbiome after the antibiotic treatment. When his face flared up with that angry and painful skin condition, the last thing on my mind was his gut health.

What is the gut microbiome and why does it matter?

Trillions of bacteria occupy our gastrointestinal tract. This community is referred to as our gut microbiome and is comprised of both harmful and beneficial bacteria. The balance of good vs bad bacteria living in our gut is what determines our gut health. Research shows that a positively balanced and diverse microbiome promotes better overall health. This is driven by the impact of the gut microbiome on our immune function, vitamin production and hormone regulation. What’s more, an imbalance of bad bacteria in our gut (known as dysbiosis) can result in a weakened gut lining. When the integrity of the gut barrier is compromised, harmful substances which would normally be excreted are able to be absorbed back into the body. These toxins can cause systemic inflammation, often reaching the skin and causing skin reactions and other immune responses. You may have heard this referred to as ‘leaky gut’.

The initial colonisation of the gut takes place during childbirth and immediately after. Babies delivered vaginally will have an intestinal microflora influenced by the mother’s vaginal flora, whereas caesarian section babies will tend to have different bacterial strains present. Breast milk contains certain bacteria which colonise the baby’s gut, as well as antibodies which influence both its gut microbiome and intestinal immune system. Formula milk will introduce different species of bacteria to breast milk, whilst different types of formula will also introduce different bacterial strains.

But there are so many other factors that will affect the gut microbiome after birth, throughout childhood and the rest of life. In fact, our gut microbes are constantly changing and the species present are impacted by what we eat, our environment and our stress levels. Identical twin studies have proven that our DNA does not dictate our gut microbiome. So the good news is that it’s never too late to positively influence your gut and improve your overall health!

Why are antibiotics harmful to the gut microbiome?

When the body has an infection it can’t fight on its own, antibiotics are given to kill off the harmful bacteria causing the infection. The downside of this is that they also wipe out a lot of the good bacteria in our intestines at the same time. As a result, people will often experience digestive problems after completing a course. Frequent use of antibiotics becomes concerning, not only because pathogenic bacteria may become resistant to their effects, but also because insufficient time is given to restore the gut microbiome between courses of antibiotic treatment. Therefore, it’s important to focus on nutrition to rebuild your gut after taking antibiotics.

How can I rebuild a healthy gut microbiome?

A nutritional therapist will work with you on your individual needs, be it healing a leaky gut, rebuilding your gut microbiome after a period of frequent antibiotics, or simply optimising your gut health. The most important foods to focus on, alongside good hydration and staying away from processed foods (particularly artificial sweeteners, preservatives and emulsifiers), are:

PROBIOTIC FOODS - These are fermented foods containing beneficial bacteria which encourage a diverse gut microbiome and include live yoghurt, kefir, tempeh, saurkraut, kimchi, kombucha and miso. Try to include a portion of probiotic food in your daily diet.
PREBIOTIC FIBRE - This fibre feeds the good bacteria in our gut to encourage their beneficial effects. It is found in foods like bananas, oats, asparagus, garlic and flaxseeds
HIGH FIBRE FOODS - Get plenty of fruit & veg, beans, pulses, legumes, nuts, seeds and wholegrains to aid bowel movement and feed the good bacteria in your gut. In fact, aim for a variety of at least 30 different fibre-providing plants per week, as this has shown to produce better gut health and overall health.
PROBIOTIC SUPPLEMENTS - Taking a probiotic supplement may encourage new beneficial bacteria to colonise the gut. The specific strain of bacteria in your probiotic is relevant, so it is helpful to work with a nutritional therapist who will prescribe the most appropriate type of probiotic strains for your age, life-stage and health concerns. In some cases, functional testing may be helpful to determine the best way to support gut healing.