Conscious Choice: The Natural Skinny on Skin

January 2000

The Natural Skinny on Skin

by Rebecca Ephraim, R.D.

Why Me?

I was born with a curse. I’m allergic to chocolate. As a little girl, whenever I ate it my forearms and outer ears would break out in a scaly, itchy rash. This was quite an effective deterrent to eating the stuff. However, as I grew older I began to press the issue with the occasional chocolate cake, hot cocoa, or movie munchy M&Ms; I’d still get a reaction — only this time my face broke out in acne! It was a cruel trade-off.

But now, several years and a nutritionist’s education later, I’ve determined that knowing my personal skin "demons" has given me relief from thinking my breakouts occur willy-nilly and that there is nothing I can do about it. Chocolate and sugar along with stress appear to be my major "triggers." Yours could be the same or they could be any of a number of other diet and environmental factors. To be sure, physicians and nutritionists in the integrative health arena agree that the vast majority of skin problems are symptoms of deeper metabolic disturbances in the body. They say conventional treatments such as steroids and antibiotics will fail to address them and can, in the long run, make matters worse.

You’re Not Alone

There are a lot of us who live or have lived with skin eruptions. Acne alone plagues about 80 percent of 12- to 25-year-olds in this country. Don’t subscribe to that old myth that skin problems cease after age 30. The National Centers for Disease Control figures twenty-nine out of every one thousand of us "older" folks between ages 18 and 44 saw a dermatologist for acne. That’s only acne and doesn’t include other skin conditions such as eczema, dermatitis or rosacea.

Regardless of the skin disorder, many are frustrated by conventional medical treatments commonly prescribed by dermatologists. Perhaps no one knows that better than those who work in the ranks of integrative medicine clinics. Susan Allen, a registered dietitian and clinical nutritionist in Chicago specializing in nutritional biochemical approaches to health problems, sees many clients seeking help to clear their skin. "They’ve done all the typical dermatologist stuff," she says, referring primarily to steroids and multiple courses of antibiotics. "They’re looking for something that will finally take care of it because nothing else has."

Not Just Skin Deep

Allen contends that skin disorders are symptoms of bigger problems going on in the body. "Ninety-nine percent of the time we can narrow it down to three things. It’s either allergies, it’s candida (Candida albicans, a yeast infection) or it’s a hormonal imbalance."

All of these are related directly to what we put in our mouths although stress, as Allen puts it, is an underlying factor that can aggravate the condition.

Antibiotics are a mainstay in conventional treatment for skin disorders. Ironically, as noted by Michael Murray and Joseph Pizzorno in their Encyclopedia of Natural Medicine, individuals treated with long-term, broad-spectrum antibiotics often develop intestinal overgrowth of candida. Candida, in turn, may actually make acne worse.

Allen says that "many, many" conservative medical doctors won’t acknowledge that candida exists as anything other than a vaginal condition in women. "I end up sending them [the patient] back to a doctor but it’s a different kind of doctor, one who’s much more integrative. They understand the nutritional implications in skin disorders so they’ll look at food allergies and yeast."

I wanted to interview a dermatologist who could speak with an eye toward integrative treatments. Interestingly, in a number of calls to integrative hospital clinics and health clinics around Chicago, I couldn’t track down a dermatologist who has a holistic bent. One integrated medicine clinic director, an M.D. who asked for anonymity, said that finding one was going to be tough, as dermatologists rely routinely on antibiotics, steroids, and other anti-inflammatory drugs to treat patients.

At another integrative clinic, acupuncturist Frank Scott said that his clinic had referred patients to dermatologists who themselves wouldn’t be considered holistic but felt comfortable treating patients who are also receiving alternative treatments with things like herbs and essential fatty acids. Scott, who subscribes to an integrative medicine approach, says that there are cases, such as an uncontrolled raging infection, in which it’s in the patient’s best interest to use "Western" medicine. However, he adds, "In a holistic setting this type of acute intervention wouldn’t be the first one [treatment] to gravitate toward."

The Skin Schism

An example of the schism that exists between conventional and complementary treatments in skin disorders is manifest in the treatments for eczema (also called atopic dermatitis), a chronic, itchy skin condition that affects up to 7 percent of the population. Children and adults can develop it at any age.

The National Eczema Society, a non-profit group steered by dermatologists to produce information, states that there’s no cure for eczema. It recommends steroids, both oral and topical, for the treatment of flare-ups. It pooh-poohs diet considerations, saying its role in the management of eczema hasn’t been ascertained. It dismisses complementary therapies, stating that there’s "limited scientific evaluation" of them. However, the society concedes that "many people have found the use of complementary therapies helpful." Go figure.

Those who practice complementary medicine and specialize in nutritional biochemistry compose another story. They consider eczema (and most other skin disorders) readily treatable with natural approaches.

Naturopaths Murray and Pizzorno believe food allergies are the major cause of eczema. Furthermore, they suggest using nutritional supplements and herbs to support the immune system. They cite more than three dozen scientific studies (i.e. Lancet, British Medical Journal, Journal of Pediatrics, etc) to support their conclusions.

Allen agrees and contends that appropriate testing will determine dietary considerations and supplement recommendations for eczema as well as most other skin disorders. "The nice thing is that it tends to be a very typical dietary protocol. . .and that’s to get rid of the sugars, to get rid of all the excess saturated fats. . .all the processed foods, to get rid of all the additives, food colorings, and dyes. It’s just, everything in our food supply lately is crap."

Robert Crayhon, M.S., nutritionist, author, and head of Designs for Health, a program of advanced training in clinical nutrition, chalks up skin problems to "toxic foods and missing nutrients. In his book, Nutrition Made Simple, Crayhon, who practices in Boulder, Colorado says, "The skin is highly responsive to optimal nutrition. Almost every skin problem can be helped through eating a more health-promoting diet."

Do-It-Yourself Primer

Testing for allergies, hormone imbalances, and yeast infection can run into the hundreds of dollars and may not be covered under insurance. Many health insurance plans dictate which labs your physician can use and, often, specialty labs are not included.

Say you want to forego a nutritional or medical consultation and try to remedy skin problems in the comfort of your own home. Nutritionist Allen says you can try changing your diet and drinking abundant amounts of pure drinking water. But you must be committed to sticking with it. "I see a lot of the time that people would rather live with their symptoms than go through the pain and aggravation of making changes in their diet and lifestyle." She concludes that this is the lure of conventional therapies, which require only the effort it takes to apply a topical solution or pop a pill. But these approaches, she says, treat the symptoms. They don’t get to the genesis of the problem.

An integrated therapeutic approach is often needed to get the desired outcome. The right supplementation is vital to correcting nutritional deficiencies that will improve digestion and liver function. This results in better assimilation of nutrients and builds up beneficial bacteria in the intestinal tract.

It may be difficult for a layperson to ascertain what (s)he needs without lab tests, and if food allergy testing is not possible, cleaning up the diet is a good place to start. Robert Crayhon advises eliminating foods such as wheat and dairy for a month to see if a sensitivity exists. Other foods, he says, such as potatoes, chocolate (I hear you, Robert), eggs, and soy products, can also cause problems. He recommends picking one food to avoid for a two-week period and then watching for improvement.

Recommended supplement support includes a wide range of nutrients. A 1993 research paper published in the Journal of the American Academy of Dermatology (Rackett, S. et al., "Diet and Dermatology" 1993;29:447-461) concluded that numerous vitamins and minerals play a key role in healthy skin by promoting circulation to the skin. That circulation, in turn, supplies nutrients and oxygen while removing waste products. The list of supplements suggested by various natural practitioners is broad and includes vitamins A, E, and C; B vitamins (particularly B6 and B12); and the minerals zinc and selenium. Essential fatty acids such as flax oil and fish oils appear to offer substantial benefits in many instances.

Dietary "no-nos" can depend on what skin problem you actually have but, overall, the natural health experts suggest avoiding or limiting refined and concentrated sugars, hydrogenated oils, fried foods, white-flour products, dairy products, and alcohol.

Murray and Pizzorno suggest avoiding medications that may cause acne: anabolic steroids, such as testosterone, corticosteroids, oral contraceptives, progesterone, and drugs that contain bromides or iodides.

Other Irritants

Managing one’s diet — that is, getting rid of the junk and adding health-supporting foods along with important dietary supplements — is the biggest factor in addressing skin problems.

However, there are a number of other considerations to take into account. Stress can’t be ignored. Relaxation has been shown in studies to stem the frequency, intensity, and duration of negative states that can aggravate skin problems and many other health conditions. For this reason, meditation, exercise, and other stress-relievers also may relieve skin problems.

Facials are a good way to get in some stress relief. Chicago esthetician Jennifer Clower is not unusual in her technique of applying stress-relieving massage and aromatherapy in her facials. In addition, Clower says that despite the fact she’s not a health care professional, clients frequently come to her looking for relief from the dry and irritated skin caused by the abrasive topical drugs often prescribed for skin conditions. She has seen mild cases of acne improve through facial treatment, though she believes that facials are more of an adjunctive aid to diet change and nutritional supplementation.

Attention to makeup and skin care products can also be part of the solution to skin problems. Clower has seen individuals with sensitivities to certain plants react to even the all-natural botanical-based products. "Research what sensitivities you have and possibly get allergy-tested if you’re having problems with certain makeups," she says. According to Clower most of the conventional makeup on the market is made by one manufacturer and simply packaged with different labeling. She suggests reading ingredient lists and avoiding chemicals such as mineral oil, which can be highly comedogenic (acne provoking).

Speaking of chemicals, industrial pollutants may also be irritants. Murray and Pizzorno say acne-like lesions can be caused by exposure to machine oils, coal tar derivatives and chlorinated hydrocarbons (i.e. dry-cleaning solvents, rodent fumigants, caffeine extractors).

Biochemical Individuality

All of this points to "biochemical individuality." This means that no two people are alike and that treatments must be designed to meet each person’s individual needs. How each of us reacts to a particular substance depends heavily on our genetic makeup, age, lifestyle, and environment. Whereas I’m allergic to chocolate, for example, you — lucky reader — may have no reaction and be able to enjoy it. In sum, then, treating skin problems effectively calls for getting in touch with yourself, and reviewing all aspects of your life. Whether you do it with the help of an integrative health practitioner or go it alone, it’s a process of self-discovery that has implications far beyond your blemishes.

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