Food, Supplements and TSW

Note: Please read my first article on how topical steroids affect our skin first so that you may understand fully the explanations below.

There are many myths and misconceptions around TSW, and the most dominant ones are regarding food and supplements. I have to stress that diet and supplements are important for overall body health, especially as TSW is taxing on the body and the body needs to replenish itself with nutrients. Diet and supplements play an important part in supporting the healing, but do not affect the skin directly and should not be mistaken for a cure.

Doctors who have studied TSW rarely mention food. Why is that so? That is because lots of information linking eczema to gut and food issues is not so relevant to TSW. Dr. Sato’s focus is on increasing the cell proliferation rate by drying out the skin and increased metabolism through exercise. Dr. Rapaport mentions diet in his list of “Misguided Therapies”. Here are some common myths about TSW debunked, I hope that this would clear up the confusion and bring you clarity on whether you should be following a strict diet or not.

Common myth: TSW is caused by leaky gut

TSW is caused by the suppression and modulation of the skin cells by the prolonged application of topical steroids. It is not caused by leaky gut, which is a separate and different condition with its own set of issues.

Common myth 2: I need to go on a diet to heal TSW

Most who come off steroids and do an IgE test would find that their IgE levels to many foods are extremely high. This is an effect from coming off the steroids that have suppressed the immune system for a long time, and this does not directly affect your skin. Your IgE levels will be higher to many foods for a period of time but this does not mean you cannot eat them or that you are truly allergic to that many foods. Your IgE levels will go back to normal again over time. If you have a food allergy, the reaction is usually clear and acute e.g. a stomach ache, anaphylaxis, hives, itching and/swelling throat or lips.

Dieting and limiting the types of food during TSW may lead to nutritional deficiencies. We need a lot more protein, lipids and other vitamins and minerals for our healing. I would discourage removing foods from your diet unless you have a clear and obvious reaction to them. Instead, please eat as many types of food as you can to fulfill your nutritional needs during TSW.

Common myth 3: I need to detox for TSW

This may be true for other skin conditions. However TSW is an issue of skin cell suppression by topical steroids. Oral steroids do not stay in your body for more than 24 hours, and the absorption of topical steroids into the system are much lower. Steroids are already “detoxed” from the body within 7 days.

The reason why the skin is damaged is because of the accumulated side effects of the drug on the skin, not from the drug staying in your system. There is no need to detoxify to heal the skin.

Why do I feel itchy after eating certain foods/after a meal?

From Dr. Sato: When you have meals, your body temperature rises due to the normal physiological response where the digestive organs become active and the body temperature is raised, causing the skin to feel warm, uncomfortable and thus itchy. When you have hot meals, your body temperature goes up. When you have cold meals, your body still has to generate heat to digest the cold food and it might even cause oozing. So just by eating you will feel itchy.

If the skin around your mouth is sensitive, sauces, gravy, acidic foods can cause skin irritation from contact with the food. However this does not mean that you cannot eat the food, it simply means the skin around your mouth is sensitive.

How can I reduce the discomfort from having meals?

Larger meals mean that the body needs to expand more energy for digestion and thus may cause more heat. I would suggest eating lighter meals more frequently. Eating cleanly and healthily will energize the body for healing.

Jay also recommends avoiding spicy foods. The heat and spice from spicy foods cause the body to heat up and irritates the skin.

Wipe your mouth after eating to avoid any leftover food/drink/sauces staying on your skin.

What about supplements? Are they necessary for healing?

Supplements do not directly affect the skin, but taking them is helpful for your health and perhaps to aid in some side effects, such as decreased bone density, poor sleep, hair loss, boosting your immunity, jerking and muscle spasms etc.

I do not have specific recommendations for supplements as I find that this varies very much according to individual needs. In general:
Magnesium and Neurobion for muscle spasms and jerking of limbs at night
Zinc and Vitamin C for general immunity
B-supplements (including Biotin and B12) for skin and hair health
Calcium and selenium for bone density

Supplements and good nutrition can supply the nutrients for your healing and replenish what is being used for healing so that you do not experience health issues from nutrient deficiency. However it does not directly trigger the cell growth/proliferation, it simply gives the nutrients needed for it.

TSW and protein

It is recommended to eat 70-80g of protein daily (actual amount depends on your body weight). Your skin is made of keratin, which is protein. It is not uncommon for people with TSW to lose lots of weight due to how much energy their body is expanding to heal. Having lots of protein will fuel your body with enough resources to generate the large amounts of skin it needs to heal!

I recommend seeing a nutritionist, not to do an elimination diet, but for some support on what high protein and nutrient-rich foods you can introduce into your diet to support your healing.

Food anxiety and phobia

Many fellow TSW friends suffer from food anxiety and food phobia. There is a lot of advice from well-intentioned family and friends who have read information for eczema and recommended elimination diets and restricting inflammatory foods to help their loved one going through TSW. However, TSW is a very different condition from eczema and dieting and restricting many foods may be more harmful than helpful. You need a lot of nourishment to heal.

TSW is a stressful and anxiety-inducing condition due to the many confusing and conflict advice out there. You do not need another stressor in your life regarding your diet. You need not stay away from many foods unless you see a clear and obvious reaction to them. Eat freely and reasonably healthily and you will still heal. The reduced stress from not worrying about your meals will help with your healing instead!

[The information referred to in this article was sourced from Skin Health Centre. https://www.skinhealthcentre.sg].