Responsibilities, expectations for dietary recommendations

Dr. Katta: “Our job as dermatologists is to be the authoritative voice on the role of diet in skin disease.”

The word “diet” can carry a stigma for both patients and physicians, but it plays an important role in dermatology. Rajani Katta, MD, attested to this in Friday’s session, “Diet in Dermatology: Translating Evidence Into Practice” (U015).

For many years, dermatologists have regularly referred to aspects of diet, such as food triggers and nutritional deficiencies, when creating care management plans to prevent and treat skin conditions. According to Dr. Katta, certain dermatologic diseases have proven to respond to dietary changes in some cases.

  1. Acne: Randomized controlled trials show that patients who suffer from acne may benefit from low glycemic index diets. The glycemic index (GI) is a scale that measures carb-containing foods and ranks them based on how they affect blood sugar levels. Patients who have acne should substitute high-GI foods for low-GI foods, such as brown rice, whole grain bread, lentils, sweet potatoes, apples, broccoli, and cauliflower.
  2. Rosacea: Accumulated anecdotal evidence has identified that certain foods and drinks, such as spicy food and alcohol, can trigger rosacea symptoms.
  3. Psoriasis: Maintaining a healthy diet can prevent comorbidities and complications, such as heart disease, hypertension, and diabetes. Overweight and obese patients who lose weight may be able to improve their Psoriasis Area and Severity Index (PASI) scores. Additionally, there is a subset of patients who may benefit from gluten-free diets. This includes people who have celiac disease or elevated serum levels of gluten-related antibodies.
  4. Eczema (atopic dermatitis): A subset of patients with eczema or AD may experience exacerbation of symptoms with certain food allergies. Patients should keep a food diary to help identify these triggers, keeping in mind that reactions can be delayed up to 48 hours. Some internet sites may suggest eliminating certain foods from your diet, but dermatologists should not recommend this without performing the necessary testing because it can lead to nutritional deficiencies. Randomized controlled trials reveal a possible gut-skin connection in patients who have AD. Adults and children more than one year of age may benefit from prebiotics and probiotics.

Dr. Katta went on to discuss the responsibility dermatologists have when prescribing diet changes to manage skin conditions.

“Our job as dermatologists is to be the authoritative voice on the role of diet in skin disease, because there is so much misinformation out there on the internet,” she said. “That means translating the evidence-based research into specific, individualized, actionable recommendations.”

In addition to a complete health history and physical exam, Dr. Katta’s approach includes evaluating possible triggers and helpers of the specific condition. For example, in patients who have psoriasis, you should check for GI symptoms and calculate their BMI. You may also consider recommending the DASH diet to reduce their risk of hypertension. In some cases, dermatologists may need to refer patients to specialists who can help institute and manage changes.

On the flip side, dermatologists should also consider the potential risks and practicality of dietary recommendations. Most evidence-based dietary changes contain minimal risk, however diets where patients eliminate certain foods could lead to poor nutrition, nutrient shortages, or unplanned weight gain.

“The other risk relates to unrealistic patient expectations,” explained Dr. Katta. “It’s really important that patients recognize that dietary change is rarely a ‘magic bullet’ treatment. Instead, it’s just one aspect of treatment.”

To help meet these expectations, dermatologists should tailor recommendations based on the individual patient and his or her probability to change. For example, teenagers who have acne are less likely to comply with a low glycemic index diet than adults. Instead, focus on them cutting back on or eliminating sugar-loaded sodas, juices, and sports drinks.

When determining if a dietary recommendation is actionable or not, Dr. Katta applies the ASE test.

“Is this treatment affordable, safe, and effective? In terms of a dietary change, that translates to: ‘Is this a change that the patient can safely implement and one that has potential benefits?’”

 

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