Eczema and dietary fiber: is fiber good for eczema? (Must read if you use probiotics)

How much dietary fiber do you need each day?

Did you know that fiber feeds the good bacteria in your gut?

Did you know there are specific types of dietary fiber that best reduce eczema?

Knowing the answers to these questions is key to maintaining eczema-free skin. 

Is gut health important to eczema?

Gut health is the golden indicator of your overall health, be it digestive, skin, mood. Your intestinal health determines how often your eczema rashes come and go.

Our gut hosts trillions of good and bad bacteria. They exist in natural balance, but often in an unhealthy ratio - the scale is tilted towards having a higher proportion of bad bacteria, e.g., a high sugar diet is linked to a higher proliferation of bad bacteria, increasing inflammation, contributing to eczema rashes.

Important to reduce sugar that feeds bad bacteria... But what feeds our good bacteria? 

Adequate fiber intake.

Increasing fiber intake feeds the good bacteria in the gut, boosting its proliferation and thus supporting skin health.

Note: we don’t need to eradicate all bad bacteria in our body, which is impossible. The goal is to recalibrate the balance towards a healthy proportion of good bacteria that we often lack.

What types of fiber help with eczema? 

Fiber exists naturally in plant-based foods like fruits and vegetables, but does not exist in meats, dairy products, and oils. Fiber exists in nature as the material that holds plants intact like a skeleton.

There are two types of fiber: 

1. Soluble fiber dissolves in your gut as a gel like substance alongside water, slowing down digestion, and supports nutrient absorption.
2. Insoluble fiber doesn't dissolve in water and adds bulk to stool, the source to your healthy bowel movements. Insoluble fiber also attracts water into the stool, making it softer and easier to pass through the digestive system.

Both types of fiber are often found in plants together. As the body will need both types of fiber, there is no need to separately monitor both types of fiber in our diet. 

Eat a variety of plant-based foods, and you will reach the required daily intake.

Fiber is also often significantly reduced or outright removed in processed foods, e.g., white bread has much less fiber than whole grain bread. So avoid these low nutrition foods.

A list of common foods including fiber content

Here are the fiber contents of common foods across categories (number as grams of fiber per 100g). 100g is around half a cup, or a large handful.

Note: 1 cup is around 200g - 236.58g. It’s a range as it depends on calculation methods and whether a food item is completely filling up the space of the cup (like sugar) or leaves plenty of space (like broccoli).

Fruits

• Prunes, dried: 7.1
• Avocado: 6.7
• Raspberries: 6.5
• Pear: 3.1
• Kiwifruit: 3
• Figs, dried: 2.9
• Banana: 2.6
• Blueberries, wild: 2.4
• Apple with skin: 2.4
• Orange: 2.4
• Strawberries, raw: 2
• Papaya: 1.7

Vegetables

• Avocado: 6.7
• Pea: 5.7
• Artichokes: 5.4
• Parsnips: 4.9
• Brussels Sprouts: 3.8
• Kale: 3.6
• Sweet Potato: 3.3
• Eggplant: 3
• Carrot: 2.8
• Green Beans: 2.7
• Broccoli: 2.6
• Cabbage: 2.5
• Chinese broccoli / gai lan: 2.5
• Corn: 2.4
• Spinach: 2.2
• Potatoes: 2.2
• Asparagus: 2.1
• Cauliflower: 2
• Onion: 1.7
• Celery: 1.6
• Winter Squash: 1.5
• Tomato: 1.2
• Pumpkin: 1.1

Beans

• Navy beans, cooked: 67
• Yellow beans, cooked: 25.1
• Small white beans, cooked: 15.2
• Chickpeas, cooked: 12.2
• Lentils, cooked: 7.9
• Lima beans, cooked: 7
• Kidney beans, canned: 6.4
• Pinto beans, cooked: 5.7
• Tofu: 2.3

Grains

• Multigrain Bread: 8.1
• Wild Rice: 6.2
• Bulgarian Wheat: 4.5
• Vermicelli: 3.9
• Barley: 3.8
• Quinoa: 2.8
• Buckwheat: 2.7
• White Bread: 2.7
• Spaghetti: 1.8
• Oatmeal: 1.7
• Brown Rice: 1.6
• Millet: 1.3
• Egg Noodles: 1.2
• White Rice: 0.4

Seeds and Legumes

• Chia Seeds: 34.4
• Flax Seeds: 27.3
• Poppy Seeds: 19.5
• Pumpkin Seeds: 18.4
• Almond: 12.5
• Sesame Seeds: 11.8
• Pistachio: 10.6
• Hazelnut: 9.7
• Pecans: 9.6
• Coconut: 9
• Sunflower Seeds: 8.6
• Peanut: 8.5
• Walnut: 6.7
• Pine Nuts: 3.7
• Cashew: 3.3

A longer list of foods and their fiber contents found here. 

Which fibers best help eczema? Does soluble fiber help with eczema?

Within the soluble fiber umbrella, there is a type of fermentable carbohydrate called resistant starch, also known as prebiotic - literally the nutrition that feeds probiotics. 

This is also the reason why many probiotic supplements usually have prebiotic fiber like chicory root or inulin in the ingredient list, to ensure the probiotic is more comprehensive.

You can read the science behind prebiotics here and here.

Conclusion for eczema patients: in addition to having a diverse plant-based diet, intentionally incorporate more prebiotic rich foods. Having probiotics is NOT enough, you need to support it with prebiotics, whether from supplement (like Metamucil) or food source.

Examples of prebiotic-rich foods (source):

• Chicory Root
• Jerusalem Artichoke
• Dandelion Greens
• Garlic
• Leek
• Onion
• Asparagus
• Wheat Bran
• Whole Wheat Flour
• Barley
• Oats
• Apples
• Raw Banana
• Konjac Root/Elephant Yam
• Burdock Root
• Yacon Root
• Jicama Root
• Cocoa
• Flaxseeds
• Seaweed

Examples of recipes and dishes high in prebiotics:

• Chicory-based drinks as a coffee replacement
• Roasted or air fried whole garlics, to pair with steak
• Generous use of onions in pasta sauces and salads
• 5-10 stalks of roasted asparagus as a pairing to main dish e.g., chicken, sea bass
• Wheat bran muffins or multigrain bread
• Banana cake
• Bread from buckwheat or quinoa
• Oatmeal or overnight oats for breakfast, sprinkled with chia and flax seeds
• Dark unsweetened chocolate as snack
• Elephant Yam noodles or its supplement form (glucomannan)
• Use of elephant yam in soups and Chinese pan fry dishes

Fiber dietary guidelines

Recommended daily fiber intake (source):

• Men, age 50 and under: 38 g 
• Women, age 50 and under: 25 g 
• Men, over 50: 30 g
• Women, over 50: 21 g

Note: The recommendation is for general dietary fiber, as there is currently no known specific requirements on prebiotic fiber specifically. 

Here are two examples of adequate fiber each day for men aged <50, so you can identify your current diet’s gap and where to add more fiber.

Example amount of fiber throughout a day’s worth of meals (US version):

• Breakfast: Oatmeal (3g), generous sprinkle with chia seeds (4g), multigrain bread (4g) with almond butter (2g)
• Lunch: Lettuce salad with sweet potato (4g), generous sprinkle with flaxseeds (6g), Roasted garlic (2g)
• Snack: Hummus dip (6g), raw carrot sticks (3g)
• Dinner: Lettuce salad with sweet potato (4g), Grilled chicken/seabass, sided with roasted asparagus (2g)

Total fiber: 40g

Example amount of fiber throughout a day’s worth of meals (Hong Kong version):

• Breakfast: One hard boiled egg, one banana (1g), multigrain bread (4g)
• Lunch: Stir fry beef with onion (1g), Gai lan stir fry with garlic (3g), one bowl brown rice (2g) sprinkled with sesame seeds (1g)
• Snack: A handful of pumpkin seeds and almonds (4g)
• Dinner: Yam noodles (6g), steamed broccoli with shrimp and egg (5g), Mapo tofu dish (3g), Chinese pork bone soup with potato, carrots and corn (4g), Pear (2g)

Total fiber: 36 g

Don’t worry if you don’t hit exactly the requirements, it just needs to be approximate. The guidelines also assume you eat an ‘average’ 2000-calories diet, so if you’re going to the gym very often and burn more calories, you could do more fiber. But if you generally at little, then you can do with less fiber, but that signals a different issues (e.g., loss of appetite, poor digestion).

FAQ: Is eczema and IBS related? (Tip: don’t eat too much fiber!)

As to most things in life, take it one step at a time. 

Insoluble fiber won’t ferment in the gut, but soluble fiber will, and produces bloating and gas.

Gradually build it up instead of diving straight into a high fiber diet. Let the digestive system adjust.

If despite building up your fiber intake gradually, you still experience symptoms like bloating, gas, diarrhea, loose stool, then you might have a different issue beyond eczema, which should be addressed first.

You may be suffering from food sensitivity to specific grains, fruits or vegetables, or you might suffer from Irritable Bowel Syndrome (IBS), which requires the low-FODMAP diet. This is why some people ask ‘is eczema and IBS related?’ The answer is, very possibly you can have both at the same time.

10 tips to increase your dietary fiber intake each day

1. Start from breakfast. It is the easiest way to make changes because you can control it what you eat at home, e.g., replace the white bread away.
2. The second easiest place is snacking. Replace your existing snack with healthy alternatives, e.g., whole wheat crackers over chips, fruits over cookies, etc. Don’t snack throughout the day? Have your fruits and nuts before/after lunch and dinner as an appetizer or dessert.
3. Add seeds to your food. Sprinkle seeds to your oatmeal, flaxseeds, sunflower seeds, pumpkin seeds, or assorted, all add your dietary fiber count. Or, if you’re okay with bigger units, throw in some walnuts, almonds or cashews into your salads.
4. Make a habit to eat some fruit or nuts after each meal as a dessert. Grab a handful of almonds. Grab a banana. Quick and simple.
5. Go for nutrient dense foods. Whole wheat bread over white bread, yam noodles over rice noodles, brown rice over white rice.
6. Take some fiber supplements like psyllium flakes, if you must. As to all supplements, they are only assistive and should not be the main source of your fiber intake. Scientifically it is unclear if supplementation alone is the same as the actual fiber from food. So your best bet is to get it naturally, and supplement a small portion of your daily requirements.
7. Eat out at restaurants serving high-fiber cuisines. Indian, Middle Eastern, Mexican, vegetarian buffets, are all fantastic options matching dining experience and fibrous nutrition. 
8. Give yourself a vegetarian day each week. Every nation has some form of “Green Monday” or “Meatless Monday”. Follow this routine to nudge yourself to eat plant-based which indirectly gives more fiber.
9. Avoid dried fruits despite containing a higher amount of fiber because they are often very dense in sugar. No go.
10. Add onions and garlic to your cooking base. Throw in some chopped onions and garlic as a dish base before you pan fry anything like chicken breast, or broccoli, or any dish in general. Or even the Bolognese sauce. Find ways to ‘sneak in’ some fiber here and there and it all adds up.

Call to action: try to recall everything you ate and drank yesterday and measure the fiber content. See if they add up to the daily recommended requirements. If not, take some action!

With all these practical examples and tips, I’d say all eczema patients should become ‘fiber eating’ experts, understanding the relationship between eczema and dietary fiber, and know how to measure your daily fiber intake (broadly) for maximum health benefits.