The truth about sugar and eczema: everything you need to know

Is sugar the all-evil culprit that you must avoid at all costs?

Can you have a slice of cake at peace?

Or do you have to become sugar-free for the rest of your life?

Wait, what about low-calorie sweeteners? Would diet Coke be relatively safe?

Unsure about these questions? This article will explain everything you need to know about sugar and eczema, e.g., is all sugar bad for eczema? Can eczema patients have fruits?

Why are we discussing sugar? The evolutionary basis for sugar consumption 

Humans are drawn to sweetness. 

Sugar helped our ancestors survive 10,000 years ago. It is fuel for the body. Sugar is a carbohydrate providing 4 calories per gram. 

So sugar is good and critical to our survival? 

Let’s use the ‘caveman/paleolithic’ mentality to answer these tough nutrition questions. The theory is that we should mimic the ancestral diet because that’s what we’re biologically adapted to. Eat only what they ate, and never eat things they couldn’t have accessed.

Sugar today is easily harvested and highly available. A Starbucks frappuccino contains 380 calories (of it comes from 54 grams of sugar) - that drink alone provides one-fifth of a typical person’s daily energy requirement.

But how did our ancestors obtain sugar? Picture knifing a thick tree that leaks white-gooey sap. Or the huntdown for a honeycomb. After an entire afternoon’s search for the correct plants, moving through forests, and the physical effort required to process end to end with bare hands. Think scarcity and calories burned from physical activity.

Sugar provides energy in ample amounts but it is NOT an essential nutrient for the body to survive today. Especially not in mass amounts in the modern diet, e.g., food products, cooking, mixer in drinks, sprinkles on desserts.

Why does sugar matter to eczema patients?

Our gut is a host of good and bad bacteria, called the gut microbiome. It is connected to the immune system, and pro-inflammatory behavior (e.g., high-sugar diet) contributes to skin rashes. 

Most eczema patients have unhealthy guts and need to fix it by reducing the bad bacteria population.

How? Remove the food that feeds the bad bacteria – sugar! 

Added sugar helps them reproduce and proliferate, which lengthens the time required to restore a healthy gut balance.

Here are three different types of sugar:

1. Added sugar

Added sugar is white sugar used in cooking, and also artificially added in most packaged products. There are many fancy names and variants of sugar, all being more or less equally harmful for the microbiome:

• Basic simple sugars: Dextrose, Fructose, Galactose, Glucose, Lactose, Maltose, Sucrose
• Solid/granulated sugars: Beet sugar, Brown sugar, Cane juice crystals, Cane sugar, Castor sugar, Coconut sugar, Confectioner's sugar (aka, powdered sugar), Corn syrup solids, Crystalline fructose, Date sugar, Demerara sugar, Dextrin, Diastatic malt, Ethyl maltol, Florida crystals, Golden sugar, Glucose syrup solids, Grape sugar, Icing sugar, Maltodextrin, Muscovado, sugar, Panela sugar, Raw sugar, Sugar (granulated or table), Sucanat, Turbinado sugar, Yellow sugar
• Liquid or Syrup Sugars: Agave Nectar/Syrup, Barley malt, Blackstrap molasses, Brown rice, syrup, Buttered sugar/buttercream, Caramel, Carob syrup, Corn syrup, Evaporated cane juice, Fruit juice, Fruit juice concentrate, Golden syrup, High-Fructose Corn Syrup (HFCS), Honey, Invert sugar, Malt syrup, Maple syrup, Molasses, Rice syrup, Refiner's syrup, Sorghum syrup, Treacle

Different types of refined sugar like white, brown, icing, raw sugars and glucose powder contain similar energy content. Sugar is sugar, no matter its color or form.

Examples of sugar content in common products (source):

More reference points:

• 5 grams of sugar (1 cube)
• 1 3-piece packet of Oreos (2 cubes)
• 1 bottle of Yakult yogurt drink 100ml (3 cubes)
• 1 slice of cheesecake 100g (4 cubes)
• 1 carton of VITA lemon tea 250ml (6.5 cubes)
• 1 can of regular Coca Cola 330ml (7 cubes)

It is NOT so practical to monitor how many cubes of sugar you eat daily. To start somewhere, count how many times you consume a high-sugar food or drink. Assume you drink a Coke twice per day, cut it once. Or swap both to lemonade. Then gradually cut it down.

2. Artificial sweeteners 

White sugar replacements are low-calorie additives that taste sweet, with minimal impact on blood sugar. There are different versions of artificial sweeteners:

• Acesulfame potassium (Sweet One, Sunett)
• Advantame
• Aspartame (NutraSweet, Equal)
• Neotame (Newtame)
• Saccharin (Sweet'N Low)
• Sucralose (Splenda)
• Luo han guo (Monk Fruit in the Raw)
• Purified stevia leaf extracts (Truvia, PureVia, others)

A list of sweetener-containing products can be found here.

Do eczema patients have a limit on artificial sweetener consumption? Is it stress-free to drink a diet Coke that is artificially sweetened with aspartame and contains 0 sugars? Which sweeteners are better?

The science is developing and it is believed that artificial sweeteners CAN affect the gut microbiome composition. But in which way, and how? And is it negligible? No one knows for sure yet. But the play-safe answer (as adopted in some countries’ nutrition guidelines) is to simply avoid sugar including sweeteners.

Eczema patients looking to nurture a healthy gut should avoid artificial sweeteners. Treating it as bad as refined sugar would be a good mentality.

3. Natural sugar

Finally, the golden question – should eczema patients restrict natural sugars, i.e., naturally occurring sugar in milk, fruits and vegetables? 

Examples of fruits high and low in sugar (source):

The quick answer: it is still a scientific debate on whether we should restrict fruit sugar or not. 

Generally, eczema patients should NOT worry about eating a few servings of fruits each day. 

But the cautious patient can test if their body feels better after temporarily removing fruits for 2-3 weeks. It is not uncommon to have sensitivities against specific fruits.

But there’s another catch: natural sugar is NOT the same as concentrated natural sugar. 

Just because a sugar is naturally made doesn’t mean it’s good. If it is highly concentrated, avoid. Eating a cup of corn is different from a dessert or cookies laden with high-fructose corn syrup. Eating a chalk of sugar cane is different from eating rice crackers that are soaked in cane sugar. Eating a beetroot is different from concentrated beet sugar drizzled in smoothies.

So what's the verdict on sugar?

The World Health Organization officially recommends adults and children to consume less than 10% of free sugars (ideally 5%) of our total energy intake. 

In a daily perspective:

• Adults should have no more than 30g of free sugars a day, (roughly equivalent to 7 sugar cubes).
• Children aged 7 to 10 should have no more than 24g of free sugars a day (6 sugar cubes).
• Children aged 4 to 6 should have no more than 19g of free sugars a day (5 sugar cubes).
• There's no guideline limit for children under the age of 4, but it's recommended they avoid sugar-sweetened drinks and food with sugar added to it. 

It’s called a recommendation, but it is more of a threshold or limit. It is not literally endorsing you to eat that amount of white sugar per day. You don't have to reach this recommendation. So if you're able to consume less sugar than the guideline, that’s ideal.

Definitions:

• Total sugar: natural sugar plus free/added sugar. This composite number is often used in nutrition labels.
• Natural sugar: naturally occurring sugar found in milk, fruits and vegetables without food processing manipulation. 
• Free sugar (‘added sugar’): added sugars (aka. free sugars) are artificial sugars and sweeteners used in food processing. ‘Free sugar’ is defined as all added sugars in any form; all sugars naturally present in fruit and vegetable juices, purées and pastes and similar products in which the structure has been broken down; all sugars in drinks (except for dairy-based drinks); and lactose and galactose added as ingredients. The sugars naturally present in milk and dairy products, fresh and most types of processed fruit and vegetables and in cereal grains, nuts and seeds are excluded from the definition. (Source)

In conclusion, follow the WHO guideline on added sugars. WHO doesn’t count natural sugars into this definition, but biologically it doesn’t make sense from a macronutrients perspective to engage in a high natural sugar diet (i.e., which would require a high-fruit, high-carb diet). 

Reducing (but not banning) total sugar would be a fair approach.

Tips to reduce sugar content in life

• Always read the ingredient label and use ‘total sugar’ as a composite indicator of health. Although labels may not display how much is naturally occurring versus how much is added, I’d still avoid anything that is too high (e.g., >5g sugar per 100g) as a general rule of thumb.
• Readjust your expectations on food. By habit we expect certain foods to have a certain taste. Pastries can be equally delicious unsweetened like plain bagels and sourdough, but also laden with sugar as in donuts and rolls. What if you don’t have to taste sweetness in bread? What if you side the pastry with a natural fruit smoothie as a drink? Then, the breakfast overall offers different tastes and can still satisfy your taste buds. Making this adjustment can reduce your tendency to order sugary versions of each food item, because likely there are plain versions of the same dish that taste equally fine. Think of the meal overall for your taste palette.
• Use natural foods to add sweetness to the dishes, e.g., bananas in pancakes, or berries and dates in salads and pastries. Get creative!
• Use natural sweeteners over synthetic versions, e.g., honey, stevia, monk fruit.
• Finally, don’t feel the pressure to have 0 sugar in your diet, which would be impossible given natural sugars exist in fruits and vegetables. But yes minimize added sugar. But don’t count in a way that may turn into an unhealthy habit that stresses you out! After all, consuming some sugary foods is still part of lifestyle and should be accepted. Find a quota that works for you, e.g., two desserts per week max.

Here are a few more quick examples to reduce your sugar consumption:

• Tone down your regular beverage. Go from frappuccino to latte. Go from latte to Americano. Go from milk tea to black tea without sugar. Request the syrup on the side for your drinks. Enjoy simple drinks like G&T over high-sugar cocktails. Every beverage has an achievable variation.
• Find your alternative energy boosters. Sometimes sugary foods and drinks are consumed for the energy boost. Try alternative energy boosters instead: meditation, deep breathing exercises, walk in the park, quick jog, walk the dog, simple at-home exercises like jumping jacks, or a quick look at the window to rest your eyes from the digital screen.
• Prolong your feeling of fullness. Sugar messes with the body’s hormonal responses relating to hunger. Have a bigger breakfast or lunch that is higher in complex carbohydrates (starches) and proteins to prolong satiety. This way you will be less inclined to have dessert or a snack between lunch and dinner.

We hope you enjoyed the detailed explanations on how sugar affects eczema, and the different types of sugar that should be avoided, and ways you can adjust them in your diet. 

Do you have any go-to tips to have a low-sugar lifestyle? Share them in the comments!