Skin manifestations of nutrient deficiencies

Interview with Yulia Brockdorf, RD, LD, CDE, CNSC.
Posted on Apr 20, 2009 by Joséphine Beck

Optiderma: In most cases, the underlying cause of chronic skin conditions, such as eczema or psoriasis, is difficult to find. There is usually more than one cause behind skin rashes related to either nutrition, stress, allergies, organ dysfunction, and much more. Eczema for instance is often triggered by food or contact allergies, but it is also believed that nutritional deficiencies have something to do with it. Do you believe chronic skin conditions are often connected with nutrient deficiency?

Absolutely. Chronic conditions are often multi factorial in their etiology and sadly nutrition is often overlooked. For example, prevalent in some regions condition like phrynoderma (toad skin) can be a sign of vitamin A deficiency, but often overlooked is the involvement of vitamins B and E. Yet it may serve as a manifestation of even a bigger picture: malnutrition.
You mentioned eczema. Food allergy and sensitivities certainly may play a role, but so may poor intake of zinc and B vitamins.

Optiderma: Why are skin disorders and nutrient deficiencies linked? Are skin sufferers more likely to develop these deficiencies?

It can pose an interesting association... Skin disorders may be warning signs of nutrient deficiencies that are disregarded by many health care providers. I would not say that skin disorders always involve higher risk of deficiencies. It is more of an association relationship since skin disorders are not rooted in one cause. Often along with skin problems, a person may experience a number of other struggles. It is amazing what we can learn from skin. If you know how to 'read' skin it may show much about the overall state of our health.
Easy bruising is one example. We see it on the skin, but it may be a sign of poor cardiovascular function, vitamin C deficiency, platelet disorders, disturbance of long chain fatty acid metabolism, or a sign of various neuropathies, etc.

Optiderma: Is there usually a predominant cause involved in nutrient deficiencies, like an organ dysfunction or a decline in the nutritional value of food?

One main cause no, but over time our lifestyle, environment, and illnesses do pay a toll on our body. As we get older, our body's ability to repair itself declines. Skin aging itself is an iceberg tip with much activity going on under the surface: inflammation, immune dysfunction, UV damage, oxidative damage on the cellular level, disruption of circulation and glandular activity. Plus when we age, our ability to absorb nutrients declines, with which we can slowly start experiencing the accumulative effect of various subclinical and subtle deficiencies.
When we look in the mirror we see a wrinkle but underneath our body is fighting a war against free radicals.

Optiderma: So it is more a question of nutrient absorption rather than a decline in the nutritional value of foods...

It’s a bit of both since soil quality will certainly impact what our produce will contain.
Take selenium for example. Food content will strongly depend on soil content. One reason I like to resort to suggesting Brazil nuts as a source of selenium is because many other sources are just not dependable any longer. Our soils vary and become further exhausted. In USA the richest in selenium soil has been identified in the high plains of northern Nebraska and the Dakotas.

Optiderma: Do you think eating organic may help?

It can. But it also depends how food was grown. Organic does not always mean clean, balanced, and well nourished. You can cut out many pesticides using organic foods. Unfortunately with today’s economy not many are able to afford it.
Sometimes locally grown food might not be certified organic but speaking with the grower, we can learn their practices and even though they are not certified, the food they produce is of great quality.

Growing body of research studies explores relationship between nitrates and increased risk of certain cancers. Some foods are more likely than others to assimilate nitrates: leafy vegetables (spinach, swiss chard, lettuce), radishes, celery, cabbage, cucumbers… I would go for organic I able. To put it in perspective - FAO/WHO Expert Committee on Food Additives established an Acceptable Daily Intake of nitrate at about 220 mg nitrate per day. A pound of green leafy spinach, for example, contains on average 300-600mg of nitrate.

On another hand peaches have a tendency to mold easily, so even organic will be sprayed with sulphur.

I suggest that when able one use organic milk products, cabbage (leaves provide lots of surface to accumulated pesticides), cucumbers, radishes, berries (or at least ask if they spray when the plant blooms or do they also spray the fruit), and greens.

Optiderma: Do you mean cow milk?

There are different schools of thought about it. At the minimum I suggest consuming milk without added growth hormone.

Optiderma: What are the best foods to include in a skin diet considering the most common nutrient deficiencies in skin disorders?

Most common association with skin conditions and nutrition / or nutrition being at least part of therapy would be vitamin D, C, Bs, A, E, K, and minerals: calcium, magnesium, and zinc.

As far as foods, berries are a blessing for the skin! So are cruciferous vegetables (cabbage family). Also we need to not forget our dear and precious fats that so many of us have a love-hate relationship with. Nuts, avocados, flax seeds, hemp seeds, olives, fish are great sources of skin nourishing fats.

There was an interesting study done by Monash University, Victoria, showing that a high intake of vegetables, legumes and olive oil appeared to be protective against skin damage. They also found statistical significance from consumption of fish, and lower intakes of butter, margarine, milk products, and sugar products.

Optiderma: And specifically for psoriasis?

I would suggest evaluating if the diet provides sufficient intake of zinc, vitamin A and omega 3 fats; riboflavin, pyridoxine... also consider evaluating food sensitivities and allergies. Several clinical studies investigated therapeutic benefits of vitamin D in the management of psoriasis.

Many proliferative skin disorders can be a sign of impaired tissue repair. See, with psoriasis we have involvement of deeper layers of the skin and presence of at times extensive inflammatory and immune processes.

Optiderma: So there is usually more than one depleted nutrient involved in skin problems...

Skin problems are often an indication of underlying issues. Depletion itself may merely be a manifesting symptom of a bigger picture. If our diet is lacking vitamin C, it is likely lacking other nutrients, such as beta carotene, found abundantly in fruits and vegetables. Lack of vitamin E can be coupled with poor essential long chain fatty acids. There is a reason for the madness when we keep asking our patients to consume a VARIETY. Your readers are likely more conscious of healthy habits and healthy lifestyle. Still, over time we get comfortable doing the same things over and over. Most people eat 8-12 foods as their staples.

Optiderma: Is it quickly noticeable if a patient is lacking of certain nutrients or do you need to do tests?

Trained healthcare provider may learn a lot from looking at person’s their skin, eyes, lips, tongue, extremities... Laboratory studies also may provide valuable information that would help guide diagnostic or therapeutic decision. And, let’s also not forget to review person’s diet.

Optiderma: So it is a good idea to see a practitioner and check possible nutrient deficiencies because you can't really make your own diagnostic...

It’s best to work with a professional. Self diagnosing can be misleading and self treatment even with seemly benign therapy may be dangerous. We need to account not only for the present concern but also other factors such as medication, other medical conditions, interactions, metabolic needs and involvements... I suggest to be cautious of working with a self professed ‘nutritionists’ many of whom are not licensed healthcare providers. Registered Dietitians are credentialed nutrition experts.

Optiderma: Could you also do an overdose of vitamins?

Vitamin A may lead to liver damage, vitamin E to decreased clotting, zinc to copper deficiency and anaemia, folate in certain population to further cancer development, niacin to liver damage, B6 to neuropathy... All of these are often used in prevention and/or treatment of various skin concerns.

Optiderma: How can you be sure your body absorbs the supplements you take? Do you believe liquid forms of supplements but also foods are better absorbed by the body?

Most certainly obtaining nutrients from foods would be the ideal. Qualified healthcare professionals may evaluate and suggest the most appropriate strategy for the individual. If supplement is recommended, for some persons liquids are preferred, when for others it is the chemical formula of the nutrient that matters, and for others the substance should be injected. But we should never forget about food itself! We often get so caught up in popping this pill and that pill and neglect the most precious source: quality food on our tables.

Optiderma: But if you have a sluggish liver, can you still absorb a good quantity of nutrients from the food you eat?

Depends on food and depends on nutrients... Some foods are used to support liver (for example animal studies showed that diet rich in oligofructose found in onions, artichoke, asparagus and garlic or extracted from chicory root, may be hepatoprotective). Absorption is dependant on gastrointestinal health, presence of necessary enzymes, adequate intestinal secretions. Healthy pancreatic secretions are important to ensure good absorption of nutrients from food or pills. Some nutrients may be chemically bound limiting their absorption while others may not be well assimilated…

Optiderma: Would you have anything to add to help people deal with nutrient deficiency?

I would like to encourage your readers to continue explore the amazing world of nutrition and not get caught up in the latest fad. Welcome opportunities to try new foods and enrich their diet with variety of colors, flavors, and aroma.

About Yulia Brockdorf, RD, LD, CDE, CNSC

Yulia Brockdorf is a Registered and Licensed Dietitian as well as a Certified Diabetes Educator, and a Certified Nutrition Support Clinician. She focuses on individually tailored nutrition therapy specific to person’s needs and situation.

Her education includes studies with emphases in Biology and Chemistry at Ternopil State Pedagogical University; Dietetics as well as Food and Nutrition degrees were completed Suma Cum Laude at the University of Minnesota, Mankato; internship was done at the University of Northern Colorado, with her practicum at Lee Memorial Health Care System in Fort Myers, Florida. Yulia continues to stay on the cutting edge of nutritional knowledge through ongoing professional education. She takes an active role in promoting the benefits of proper eating at home and abroad. She has appeared on radio, in newspapers, and done international work in nutrition education for medical professionals and the public.