Most of us, from time to time, get skin rashes or wounds that usually heal and resolve quickly. Sometimes though, skin rashes or wounds do not heal and become a chronic problem. The ability of our skin to heal has a lot to do with our nutritional status and malnutrition can be an enormous factor in whether our skin has the tools to be able to heal. This is why slow-healing wounds and ulcers are fairly common in the elderly population. This is because of the age-related decline in digestive health and reduced ability to absorb nutrients, along with other factors such as immobility and chronic age-related inflammatory conditions.
My Skin Health Story
When my health is compromised, it always shows up in my skin. I have had two instances in my life where my skin conditions did not heal and both times I can see now that I was severely nutritionally depleted.
The first time was about 20 years ago when I was 26. I had a spot on my leg, not sure how I got it, but it just wouldn't heal and after a while, it kept oozing yellow pus, so it obviously got infected. To be honest, I just stuck a plaster and some antiseptic cream on it and ignored it for a while, but eventually, I went to the doctors about it and they prescribed me antibiotics. The course of antibiotics didn't seem to help though, and the spot progressed to further spots on my legs over the next 2 – 4 weeks. My doctor continued to prescribe further courses of antibiotics, but the skin rash would not heal and progressed over the next few weeks to widespread eczema over both legs, which was very uncomfortable.
I was so stressed out as I was due to go on holiday to Egypt and couldn't even walk because of the oozing lesions on both legs. My doctor then prescribed me more antibiotics and a heavy-duty steroid cream, which finally cleared it up over the week before I went on holiday. I had a fantastic trip to Egypt and my skin seemed like it was finally healing, most likely because of the sunshine and low-stress levels. I had awful scars all over my legs so wore trousers, but I finally felt this nightmare was behind me.
Unfortunately, this didn't last long as when I returned from my holiday, it came back with a vengeance and I ended up on more antibiotics. Alarmingly, I spent nearly 2 months on antibiotics. Had I known at the time, the impact that almost 2 months on antibiotics would have had on my health, I probably would have done things differently. But I did not realise this until later on as probiotics and gut health were still emerging science at that time and none of the dermatologists and doctors who dealt with me ever talked about probiotics or gut health.
So how did I heal from this?
The antibiotics were not helping, so I started doing my research and wondered whether it was actually the antibiotics causing the condition by depleting my gut bacteria, and as I result I developed food intolerances that were triggering my skin condition. I did a pinprick IgG Food Intolerance test through a company called York Laboratories in the UK and discovered I had several severe food intolerances to gluten, wheat, yeast, dairy, and some other milder intolerances as well. It took a long time to heal, but starting the probiotic therapy and removing gluten and dairy (I also discovered at the time that I had Coeliac Disease) made a tremendous difference. This lead me down the path of gut healing and inspired me to study nutrition and later become a GAPS practitioner specialising in gut healing.
The point of my story is that it may not always be an infection that is slowing the skin healing process. There are also other factors to consider, such as gut health, stress, and nutritional deficiencies, which can all affect the skin's ability to heal. I was severely malnourished at the time with an extremely compromised digestive system. My Coeliac Disease caused inflammation in my gut, preventing me from digesting and absorbing nutrients. I was very underweight and malnourished.
I am still paranoid to this day about getting skin infections as this was obviously what triggered all my health issues, but colloidal silver cream is my saviour. As soon as I get a skin flare-up, I cover it with colloidal silver cream and it clears it up fairly quickly.
The second time in my life I had problems with skin healing was after the birth of my son, who is now 14. I would get a scratch that just would not heal and would suppurate and ooze again, getting infected easily. I also had hormonal spots on my face that took weeks to heal and I remember going for a job interview when my son was about 8 months old and I had some really ugly spots on my face that tried to hide badly with concealer. I looked terrible. As I was still breastfeeding and still in the postpartum phase, I was severely depleted of nutrients, especially iron as I had a postpartum haemorrhage during labour and it took me a couple of years to get my iron back up to an optimal level once again. I explain later in this blog how low iron can affect skin healing.
The good news for anyone who is worried about the effects of a long terms course of antibiotics is that you can rebuild from this and reclaim your health. My health over the last 12 years has been the best it has ever been, and I even gave birth to a healthy baby girl at age 44, which would be hard to do if your health was compromised.
So how does our gut health impact our skin health?
Hippocrates once said way back in 370 BC that `All diseases begin in the gut’ and it is only now that we are realising how true this really is. We can link most health issues, no matter what your symptoms are, to poor gut health. This is especially true with skin conditions.
The gut and skin connection
Inflammatory skin conditions such as acne, eczema, psoriasis, dermatitis, and rosacea are very common and from a medical perspective, they are treated topically from the outside in with medications that suppress the symptoms, although often the relief is temporary until the next flare up is triggered.
How healthy our skin looks is a direct reflection of how our internal body is functioning. To successfully support the healing of skin conditions and wounds we must look to support the health of our skin from the inside out, and as 80% of our immune system is in our gut, we must focus on optimising our gut health as a priority and the function of our digestive system.
Food allergies and intolerances
As I discovered with my journey, food allergies, and intolerances are often common triggers for inflammatory skin conditions when digestion is impaired and the health of the gut lining is compromised, a condition referred to as intestinal permeability or leaky gut.
As foods entering the digestive system are the largest source of foreign material entering the body, it makes sense that food intolerances are one of the biggest triggers of inflammatory skin conditions. It is therefore important to look at how the body digests and absorbs foods, as it is the incomplete breakdown of food proteins that can often trigger inflammatory skin reactions when the tiny particles travel through the leaky gut lining and into the bloodstream.
What is leaky gut?
Leaky gut is a condition that occurs because of the development of gaps between the enterocyte cells that form the membrane lining of the intestinal wall. The gaps between the enterocyte cells enable undigested foods, bacteria, and metabolic wastes, that should be confined to the digestive tract, to travel into the bloodstream.
The food particles are problematic because they are undigested, and not fully broken down into amino acids, glucose, and fatty acids, which are forms recognisable to the body. As undigested food particles are not supposed to be in the bloodstream, circulating immune cells register the food particle as a foreign invader and create antibodies against it for future encounters. Eating the food again will cause the immune system to trigger an inflammatory response in the body. This is how food intolerances and sensitivities manifest. It is often the overconsumption of a few foods that leads to food intolerance reactions as repeated exposure overstimulates the immune response.
Specialised mast cells sit within the lining underneath the skin. Food allergies and intolerances as a consequence of leaky gut stimulate these mast cells to release histamine, which causes inflammation and itchiness.
Before I detail about the specific nutritional deficiencies that impair the healing of the skin, here are some proven tips to improve your ability to digest and absorb nutrients from foods and heal your intestinal lining.
Tips to improve digestion and support gut healing
Eliminate trigger foods. Investigate food intolerances by either using an elimination protocol and food journal or intolerance testing under the guidance of a natural health practitioner.
Take a probiotic daily to help restore gut flora and gut barrier function. Researchers have intensively studied the clinically researched strain Lactobacillus Rhamnosus (LGG) for its beneficial effects on eczema. Research has shown that LGG can help reduce the symptoms of eczema, and when given to pregnant and breastfeeding women, LGG helps reduce the frequency and severity of eczema in their children.
Regularly consume fermented foods such as sauerkraut, kimchi, kefir, probiotic yoghurt, and kombucha. Fermented foods contain trillions of naturally occurring beneficial bacteria which have a probiotic action in the gut.
Skin problems are often linked to poor digestion, in particular, poor protein digestion in the stomach because of an inefficient production of stomach acid. We can take a digestive enzyme with meals, to ensure that food is digested and absorbed properly, so it doesn't become fuel to feed bad bacteria and cause food reactions.
Have regular homemade meat stock, as it is very soothing and nourishing for the gut and is one of the principal healing foods on the GAPS Diet. The gelatin and nutrients found in meat stock are the glue that helps to heal and seal the intestinal lining.
Drink warm water with the juice of half a lemon in water 20 minutes before main meals to help boost stomach acid production naturally. This will help you digest and absorb nutrients more effectively. 1 tablespoon of Apple Cider Vinegar with the mother culture will be just as effective. Eat plenty of soluble fibre from fresh fruit and vegetables to keep you regular, so toxins and wastes don't need to be eliminated via the skin. Have a handful of mesclun salad greens on the side of your plate regularly. These bitter greens are great for the liver and stimulate digestive juices.
What are the nutritional deficiencies that impair skin healing?
The body needs an optimal nutritional status for the skin to progress through the various stages of skin and wound healing. Various nutritional deficiencies can impair this process. The main ones are protein, zinc, iron, vitamin C, vitamin A, and vitamin D. I will focus on each of these.
Protein is extremely important for skin and wound healing, as it is an essential building block for the growth and repair of cells and tissues. Protein deficiency decreases the amount of collagen available in the skin, which slows the healing process. `Protein significantly affects the entire process of wound healing through their role as RNA and DNA synthesis, collagen, and elastin tissue formation, immune system function, epidermal growth and keratinisation’ (1)
Good protein sources are beef, lamb, chicken, eggs, fish, cheese, nuts, seeds, lentils, and chickpeas. I was vegetarian at the time of my slow-to-heal skin lesions, so I wonder if protein deficiency played a part in this, as I didn't have the greatest diet.
The micronutrient zinc is one of the most important nutrients for skin and wound healing as it is involved in protein and collagen synthesis and tissue growth. Zinc deficiency results in slow wound healing and reduced skin cell production. Stress also depletes zinc, so deficiencies can occur more often during stressful periods.
Excellent sources of zinc are oysters, pumpkin seeds, beef, lamb, lentils, mushrooms.
When the body is deficient in iron, there is a poor blood supply to the skin, which can impair skin healing. This is because the skin is not getting enough oxygen, which is needed to promote skin healing and deal with infections.
Iron-rich foods to include in your diet are beef, lamb, pork, liver (haem sources = higher absorption) beetroot, leafy greens such as spinach and kale, beans, lentils, tofu, avocado, molasses, dried fruit (non-haem sources = lower absorption)
Vitamin C plays an important role in the synthesis of collagen, the formation of new blood vessels, and helps to strengthen the skin and the wound while it heals. A deficiency in vitamin C delays wound healing. Vitamin C-rich foods also assist with the absorption of iron.
Food choices to include in your diet that are rich in vitamin C: red peppers, broccoli, citrus fruits,
strawberries, kiwifruit, tomatoes, spinach, cabbages, and potatoes.
A deficiency of vitamin A also delays the healing of the skin and increases susceptibility to infection. Vitamin A also helps to stimulate collagen, which is the glue that holds everything together so is important for skin structure.
Food choices of preformed vitamin A (retinol) are cod liver oil, liver, egg yolks, butter, and dairy products.
The upper intestines and liver convert food rich in beta carotene (pro-vitamin A) to the retinol form of vitamin A. We can find beta carotene in yellow and orange-coloured fruits and vegetables and leafy green vegetables and can eat it in abundance so we don't have to worry about the toxicity that associated with too much of the retinol form of vitamin A. Good sources of beta-carotene are carrots, pumpkin, red cabbage, sweet potato, winter squash, apricots, mango, cherries, papaya, peaches, watermelon, asparagus, broccoli, Brussel sprouts, kale, lettuce, parsley, and spinach.
It makes sense that Vitamin D is a key nutrient for skin healing, as sunlight exposure can really help to heal inflammatory skin conditions, especially eczema, and psoriasis. This could be why my skin condition in my 20s really healed up when I spent a week in Egypt.
For most people, sunlight exposure is their major source of vitamin D, as sunlight stimulates the production of vitamin D3 in the skin's epidermis. However, as we get into the cooler months of the year and we spend more time inside, many people become deficient.
If you have slow-healing wounds, taking vitamin D as a supplement would be beneficial as a 2020 study found a correlation between low vitamin D levels and hard-to-heal wounds and skin conditions (2)
Vitamin D also has antimicrobial properties which can protect the skin from infection. `When the skin is injured, a higher amount of vitamin D intake will enhance healing and better outcomes. Additionally, Vitamin D promotes the creation of Cathelicidin, an antimicrobial peptide the immune system uses to fight off skin infections. (3)
As well as sunlight food sources of vitamin D are cod liver oil, beef liver, sardines, salmon, tuna, and dairy products.
So in summary, poor nutrition before or during the skin healing process can delay the healing of wounds and skin infections. Eating a whole foods diet rich in nutrients such as protein, zinc, iron, Vitamin C, and vitamin A, and getting out in the sun for at least 15 minutes in summer and 1 hour in winter can be a great starting point. If your skin condition continues, it would be worth exploring your gut health and whether any food intolerances or sensitivities are triggering the immune system and causing a reaction in the skin.
Dryden et al. Wound Management and Nutrition for Optimal Wound Healing. Atlas of the Oral and Maxillofacial Surgery Clinics (2013) 21 (1) 37-47. Pubmed.ncbi.nlm.nih.gov
Smith K, Hewling S, Correlation between Vitamin D levels and hard to heal wounds: A Systemic review. J Wound Care, July 2020, 1: 29 (sup 7) S24 – S30.
Regulski M. Addressing Vitamin D Deficiency in the Wound Care Clinic. Nov 2016. Sourced from hmpgloballearningnetwork.com