Nutrition homepage

Nutrition 3701

Lecture 19

ECZEMA-29 October 2010

 

IMPACT OF DIET

               

                Vitamin A

 

                Allergy

                                Nickel

                                Breast feeding

 

 

                Preventative dietary therapy for children to prevent atopic dermatitis

 

                Dietary Deficiencies (elimination or reduction causing dermatitis

                                Riboflavin

                                Biotin

                                Essential fatty acids

                               

 

 

 

 

               

VITAMIN A

 

Dose issue in food-more on vitamin A in the next lecture

Issue of dermaceuticals

 

 

ALLERGY

                       This refers to atopic dermatitis and point up the problem with functional foods

 

                               

Diet allergens interact with IgE antibodies bound to mast cells the mast cells release IL-4,5,6 and TNF-a (early response)

 

These cytokines are pro-inflammatory and act accordingly through the IgE mediated late response

 

Leukocytes are attracted and stimulated to release their own pro-inflammatory cytokines

 

Allergy-Nickel

                               

                                Nickel sensitivity or allergy found in fasting persons given 600 mG nickel in water

                                                -likely atopic dermatitis

               

                                also in nickel rich foods like chocolate, nuts, beans, porridge oats

 

 

 

 

 

 

 

Allergy- Breast feeding

 

                                Various proteins can lead to atopic dermatitis

 

                                Elimination therapy by infant or mother

 

Infants with recent atopic dermatitis-breast milk with higher ratios of linoleic to the total of            gamma-linolenic, dihomogammalinolenic , and arachidonic acids-this is consistent with the concept of lowered gamma-linolenic     and  dihomogammalinolenic acids in atopic dermatitis patients-lowered PgE1 allows for IL-4 driven IGE synthesis

 

 

The fatty acid ratios may explain why breast feeding does not always prevent atopic dermatitis

 

 

 

 

Preventative dietary therapy for children to prevent atopic dermatitis

 

Prevalence and incidence of atopic dermatitis down in children if:

 

                Kids prolonged breast feeding is anti-allergenic

 

                                                                -avoidance of cow’s milk

                                                                -immunoprotective factors in breast milk

 

                                                a diet free of cows milk and eggs to nursing mothers

 

            supplementation of  soya formula containing sucrose when breast milk is not available

 

 

Cooking and other technological advancements

 

 

                                                In meat based baby foods

 

Reduction of severity of response to skin prick antigen (meat)  test  in atopic dermatitis infants fed milled or freeze dried meats in comparison to steam cooked meat

 

 

Dietary deficiency

 

                Riboflavin

 

                                Deficiencies of riboflavin lead to dermatitis

 

Via conversion of vitamin B6  to its coenzyme (necessary for elongation of  gamma linolenic acid to arachidonic acid)- consequently there is less DGLA formed

 

 

OR

 

                                Curtailed conversion of tryptophan to niacin-role of niacin in atopic dermatitis is unclear                   

 

 

                Biotin deficiency

 

Mechanism is unclear but as linoleic acid is elevated and dihomogammalinolenic acid is decreased it is suggested that an interference with delta 6 desaturase and or the elongase that follows

 

               

 

                Essential fatty acids

 

                                Omega 6

               

Gamma-linolenic acid is low in the skin and therefore dihomogammalinolenic acid is low in the skin in atopic dermatitis

 

This deficiency of gamma linolenic acid and its sequelae particularly comes up in parenteral nutrition that is deficient in lipids

 

This raises the issue of whether linolenic acid is essential as opposed to linoleic acid being essential

 

 

 

                                Omega 3

 

                                                Issue of alpha-linolenic fatty acid versus eicosapentaenoic acid essentiality

 

            Recall that eicosapentaenoic acid is anti-inflammatory

 

 

                                                Fish protein  can cause allergy so source of eicosapentaenoic acid is important

 

 

 

 

 

ECZEMA

 

FUNCTIONAL FOODS AND NUTRACEUTICALS

 

 

               

FUNCTIONAL FOODS

 

Such foods are really only functional by elimination or by meeting dietary deficiencies and that is not really a definition of functional foods

 

Designer functional foods

 

           Use of fish- fish protein allergy is an issue for some

               

 

DERMACEUTICALS

 

Retinoic acid-skin creams reduces seborrhoeic dermatitis skin flakiness by inhibiting oil gland activity but it stimulates the inflammation of atopic dermatitis

 

 

NUTRACEUTICALS

 

    ATOPIC DERMATITIS

 

          EVENING PRIMROSE OIL

 

                  Plasma PGE1 AND PGE2  profiles are identical between atopic dermatitis and healthy controls

              What is the significance of this observation

 

 

FIOCCHI –fed 3 g/day of  GLA in the form of evening primrose oil for 4 weeks to children with infantile atopic dermatitis

 

    A significant decrease in sleep interruption and itching requiring anti-histamine or corticosteroid therapy

 

        Uncontrolled and short duration failed to account for cyclical nature of atopic dermatitis

 

 

BIAGI- fed children with atopic dermatitis a supplement of  22.5 mg GLA /kg  body weight/day  in the form of a 50/50 min (olive oil/evening primrose oil) or 45 mg GLA/kg bodyweight per day (pure evening primrose oil) for 8 weeks

                          Only 45 mg dose produced clinical improvement

 

ISSUES

 

 

WHITTAKER- no improvement in atopic dermatitis patients taking 600 mg GLA/day for 16 weeks in the form of evening primrose oil-complicated by the use of emollient and corticosteroidal cream   

 

DOSE IS NOT AN ISSUE  ??  DURATION OF TREATMENT NOT AN ISSUE??

 

 

 

 

HEDEROS- saw improvement with evening primrose oil in atopic dermatitis patients but used an analogue scale up to 100 (worst ever seen by physician) and reports of child itch by parents

 

                                      ISSUES

 

 

 

LEHMAN- atopic dermatitis patients-decreases in LTB4 (pro-inflammatory) from leukocytes from patients on evening primrose oil (540 mg GLA/day for 12 weeks

 

The rise in leukocyte DGLA and DGLA/AA ratio may explain this decrease

 

      BORAGE OIL

 

BAHMER- atopic dermatitis patients-a positive study used only one patient

 

ANDREASSI- atopic dermatitis patients fed 548 mg GLA/day in the form of borage oil for 12 weeks-clinical improvement compared to placebo

 

HENZ-  saw improvements only in those who had significant rises in erythrocyte DGLA levels-however this was only a small percentagew of the the patients-suggests borage oil was only effective in a select group

 

 

                                                COMPARE TO EVENING PRIMROSE  OIL

 

 

        BORAGE OIL

TOLLESON AND FRITZ- topically applied GLA (0.05 mg/kg body weight) topically applied GLA in the form             of borage oil in the nappy area of children with infantile seborrhoeic dermatitis and age matched healthy controls              twice a date for 4 weeks-improvements in terms of loss of lesions   

TOLLESON AND FRITZ- topically applied GLA (0.05 mg/kg body weight) topically applied GLA in the form         of borage oil in the nappy area of children with infantile seborrhoeic dermatitis and age matched healthy controls          twice a date for 4 weeks-improvements in terms of loss of lesions   -however there was no control group

 

 

     BLACKCURRANT OIL

 

                                Nothing done

 

     FUNGAL OIL

 

                                Nothing done

 

 

         FISH OIL

 

                                Widespread success-why omega 3 superior?

 

                                                Brings omega 3 to omega 6 ratio closer to ideal?

                               

                                                Other reasons?