Eczema (also known as atopic dermatitis) is a very common autoimmune disorder (presenting on the skin) that affects more than 3 million people per year and is often seen in children and adolescents Most treatments are topical and are only palliative–they treat the symptoms, not the cause. The skin our largest organ, and whatever presents on the skin is usually due to a systemic problem. People with eczema are experiencing an immune response to systemic inflammation, which can be caused by diet and some individual specific triggers. As always, I recommend a paleo diet; the elimination of all wheat, grains, processed foods and sugars; and the addition of anti-inflammatory foods and/or supplements as the most important interventions to ameliorate systemic inflammation. Repairing the gut microbiome is essential, and can be done with proper diet and the addition of a quality probiotic.
Here, we will discuss a recent discovery in genetics and how it relates to eczema, followed by how studies demonstrate that amino acid supplementation can treat and prevent eczema.
Does eczema run in your family?
It is well known that eczema is more common in people who have a family history of the condition–but why? Finally, we have some answers. For some patients, there could be a genetic explanation. A team of scientists studied a group of people with severe eczema/atopic dermatitis, and discovered that mutations of a gene called CARD11 appear to be involved its development (National Institutes of Health [NIH], 2017). They then confirmed that family members of the participants also had the mutations, and also had eczema.
What does a CARD11 do?
CARD11 gives instructions to a protein (also called CARD11) that stimulates cells of the immune system called T cells by activating the protein complexes NF-κB and mTORC1. You don’t need to fully understand NF-κB and mTORC1 for our purposes. You don’t even need to know what the the acronyms mean. Here is what you do need to know:
Mutations in the CARD11 gene interfere with the proper activation of NF-κB and mTORC1. In particular, mTORC1 helps transport the essential amino acid L-glutamine into cells, and plays a major role in the normal building of proteins. Another amino acid that promotes normal mTORC1 functioning is L-Leucine.
NF-κB plays a role in determining a cells response to stimuli such as stress, free radicals, toxins, oxidation, bacteria or viruses. It is well understood that abnormal regulation of NF-κB (remember: CARD11 mutations clearly cause this abnormal regulation) leads to autoimmune diseases (like eczema) and other immune system malfunctions.
Do you have a CARD11 mutation?
Well, if other people in your family have eczema, it is probably safe to assume that you do. At the very least, you can assume that there is most likely some genetic explanation. If you are reading this and are feeling worried about it being in your genes, it is important to realize that something being “in your genes” does not mean there is nothing you can do about it. I am a firm believer in the saying: “Genetics load the gun, but environment pulls the trigger.”
You can change your fate by providing your body with what it needs to overcome this genetic defect. The findings of the CARD11 study suggest that:
“Supplements of the amino acids glutamine and leucine might help reverse the defects caused by these mutations.” National Institutes of Health, 2017
Interestingly, the evidence that supports the efficacy of amino acid supplementation for eczema is not dependant on whether or not you have a CARD11 mutation. It appears that specific amino acids help eczema sufferers anyway. So, if you are the only person in your family with eczema, don’t worry. These same amino acids can help you just the same! It seems that regardless of the presence of genetic mutation, the same amino acids support the systems that are failing all eczema sufferers. Which brings me to our discussion of those amino acids…
L-glutamine is a conditionally essential amino acid. In addition to the study we have already discussed, many other studies demonstrate L-glutamine is effective for eczema. One study discusses the role of cytoplasmic phospholipase (an enzyme responsible for signaling an inflammatory response) in atopic dermatitis, and how L-glutamine can inhibit that enzyme (Cho et al., 2012). Inhibition of cytoplasmic phospholipase via L-glutamine supplementation seems to suppress inflammation, itching, and dermatitis (Cho et al., 2012). Although the inflammatory response in this study was induced artificially, the actions of L-glutamine were impressive. L-glutamine also plays a significant role in maintaining the skin barrier by generating natural moisturizing factors and combining with other amino acids to protect the skin against staph infections (Aoki et al., 2016). Other amino acids that play a role in maintaining the skin barrier include L-histidine and L-arginine (Aoki et al., 2016).
“Leucine is an important component in the process of tissue regeneration and development. Therefore, it can aid improvement of skin lesions and modification of skin barrier function.” – Choopani et al., 2017, Journal of Evidence Based Complementary and Alternative Medicine
In addition, some animal studies have demonstrated that L-leucine supplementation improves skin elasticity, moisture, and wound healing (Hwang et al, 2017; Chinkes et al., 2004).
L-histidine is an essential amino acid, which means we must obtain this amino acid from food. A study conducted by Brown et al. (2017) demonstrated that L-histidine could be a “safe, convenient, nonsteroidal intervention suitable for long-term use in the management of eczema, particularly in children.” There is not a lot of additional evidence that supports this specifically, but we do know that L-histidine has anti-inflammatory, antioxidant, and immunomodulatory abilities, and and is required for the production of histamine (National Center for Biotechnology Information, 2018).
One more thing . . .
One important cofactor for these amino acids is Vitamin B6. Vitamin B-6 is a water-soluble vitamin first discovered as a factor that was able to cure dermatitis in rats (Field & Stover, 2015). This is likely because B6 is a cofactor necessary for more than 100 enzyme reactions in the body (NIH, 2018). Vitamin B3 is important for L-Leucine as well. Are all the B vitamins in your multivitamin? If not, you might consider taking a B complex. I like this strawberry flavored one by EZ Melts because it contains methylated folate and B12.
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Aoki, V., Orfali, R., Samorano, L., & Zaniboni, M. (2016). Skin barrier in atopic dermatitis: beyond filaggrin. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4999106/
Brown, S., Gibbs, N., Griffiths, C., Tan, S., & Weller, R. (2017). Feeding filaggrin: effects of l-histidine supplementation in atopic dermatitis. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5634381/
Chinkes, D., Wolfe, R., & Zhang, X. (2004). Leucine supplementation has an anabolic effect on proteins in rabbit skin wound and muscle. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15570031
Cho, B., Im, S., Jin, Z., Jung, S., Kim, H., Lee, C., Lee, H., & Shin, S. (2012). Glutamine suppresses dinitrophenol fluorobenzene-induced allergic contact dermatitis and itching: inhibition of contact dermatitis by glutamine. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22727501
Choopani, R., Fekri, A., & Mehrbani, M. (2017). Treatment of Atopic Dermatitis From the Perspective of Traditional Persian Medicine: Presentation of a Novel Therapeutic Approach. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871194/
Field, M. & Stover, P. (2015). Vitamin B6. Retireved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4288272/
Hwang, J., Lee, J., Lee, W., Park, J., Shin, H., & Song, S. (2017). Oral Administration of Glycine and Leucine Dipeptides Improves Skin Hydration and Elasticity in UVB-Irradiated Hairless Mice. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5590797/
National Center for Biotechnology Information. (2018). Histidine. Retrived from https://pubchem.ncbi.nlm.nih.gov/compound/L-histidine
National Institutes of Health. (2017). Gene mutations suggest potential treatment strategy for severe eczema. Retrieved from https://www.nih.gov/news-events/nih-research-matters/gene-mutations-suggest-potential-treatment-strategy-severe-eczema
National Institutes of Health. (2018). Vitamin B6. Retrieved from https://ods.od.nih.gov/factsheets/VitaminB6-HealthProfessional/