Treating Eczema With Functional Medicine: 101

Understanding  an eczema outbreak is really complex. And like a child learning language, you have to understand the alphabet and sounds first before you can talk. Same goes for eczema.  To really understand an eczema outbreak, you have to first understand the difference between the way functional medicine and conventional medicine views it.

Why Functional Medicine?

Functional medicine (FM) is a “systems” way of thinking. And when we say “systems,” it’s not like conventional medicine that views the body as a group of isolated systems where you have a cardiologist for the heart, an endocrinologist for hormones, etc.  In FM, we view the systems, or areas of the body, as operating as a whole response to the environment (kind of like the operating system of a computer).

It makes perfect sense because each area influences the others.

A good analogy to think about functional medicine versus conventional medicine is to think about a tree. Visualize the entire tree with its roots, trunk, branches, and leaves.  Conventional medicine looks at one branch, whereas functional medicine views all of the branches, trunk, and roots. It’s going to look at the leaves and even further in-depth because we really want to understand what’s going on in the entire person.

When we do this, we take a really detailed history and look for root causes. It’s interesting that we look for root causes and use the tree analogy, because the goal is to find out what is foundationally disrupted in your body to figure out what’s causing the eczema flare

Regarding eczema, conventional medicine really tends to see it as something that doesn’t truly have a cause yet. When I was told that I had eczema the doctor said, “You’ve got eczema. There’s no known cure. See you later.” However, in functional medicine—and now even in the medical literature (check it out here)—they’re starting to talk about it as an autoimmune condition and starting to identify some causes of it. And that’s what we’re going to get into here a little bit later.

This is why taking a FM approach to looking at eczema really can help you get down to why things are happening.

The ATM Model

One of the foundational principles of understanding functional medicine is the concept of antecedents, triggers and mediators. We call it the ATM model. These are how a functional medicine practitioner frames an understanding of your entire life history and contributing factors to your condition. We’re looking at all of that to figure out how you got to where you are today.

Let’s start off with the antecedents. An easy way to think of those are those are the predisposing factors. Those are the things like genetics and family history, lifestyle, past illness, exposure (occupational or environmental exposures). Those are all the things that are going to essentially be the foundation for the cause of illness.

A key point regarding genetics and family history is that they aren’t life sentences. A lot of people think, “Oh, there’s cancer in my family. I’m going to get cancer.” That’s not necessarily the case. There’s a lot of things here that are modifiable that can prevent you from actually having that illness even though you might be very prone to having it. Great news!!

Triggers are what provoke the signs and symptoms of illness. Those are along the lines of infections, allergens, toxins, radiation, surgery, social conditions, and things of that nature. They’re going to combine with the antecedents to actually cause more signs and symptoms.

Last, the mediators perpetuate the illness. You can think about those on a biochemical or psychosocial level. Biochemically speaking, hormones, neurotransmitters, metabolites, free radicals, and inflammatory chemicals are what perpetuate what’s going on. Once you have that genetic factors, plus the triggers, these mediators keep that cycle going. In the case of eczema, it’s going to cause the flare to continue.

The psychosocial factors—stress, thoughts, beliefs, community- are extraordinarily important in this model, but also in eczema.

Eczema ATM’s

Genetics, family history, lifestyle, past illness, and environmental exposures are key antecedents for everyone. For example, if you have certain historical factors like a family history of autoimmunity or allergies, asthma, and eczema (the allergic triad) you’re much more likely to get eczema than the rest of the population.

The most common triggers I see in practice are infections, allergens, toxins, diet, and dysbiosis (an imbalance in the microorganisms in your body—not just in your gut, but all over your body).  In eczema, skin dysbiosis can be an important piece of the puzzle too.

The primary mediators of eczema are (without getting too crazy science-y):

  • Hormone imbalances (especially from stress and sex hormones). Cortisol, DHEA, estrogen, progesterone, and testosterone imbalances can perpatuate inflammation and make eczema flares worse.
  • Depleted Nutrients. In practice it’s usually omega 3 fatty acids, vitamin D, antioxidants such as vitamin C and selenium, and minerals such as zinc and magnesium.
  • Inflammatory chemicals. Histamine, cytokines, and free radicals are major contributors here.
  • Impaired liver function. If you’re liver can’t function optimally, you can’t clear metabolic waste, toxins or hormones efficiently which are essential for a healthy gut and skin.
  • Leaky gut. This occurs when many of the above factors cause increased intestinal permeability allowing things into the bloodstream (like bacteria, toxins, proteins, etc.) that shouldn’t be there. This causes inflammation and immune system activation driving the eczema cycle.

I find for most of my clients is that stress is often the most significant factor, either as a trigger or as something that’s perpetuating, or both.

To recap- if you’re having an eczema flare or a flare-up of any autoimmune condition-  you’re looking at the antecedents + the triggers + the mediators= cause of flare. It’s a cyclical process that self-perpetuates until you identify the triggers and the root causes to stop this cycle. You must eliminate the infections, hormone and nutrient imbalances, allergens, foods, etc., to get this cycle to stop.

Then you actually need to take the proper steps to heal it (replacing nutrients, healing leaky gut, balancing hormones, improving liver function, etc.).

Real Life Eczema Example

I’m going to use myself as an example. I’m not necessarily proud of this, but we’re all human 😉

I was driving home from my sister’s this past Halloween. I had just thought to myself that I was so excited because I didn’t have any Halloween candy. But then I had brain lapse and I ate a piece.


About an hour later, it triggered a flare. And for me, the area where my eczema always, always, always starts is my left wrist and my left hand. They started itching like mad. I was scratching for four hours. And immediately, I went downstairs and took some anti-inflammatory nutrients because I knew I had to get at that flare before it became a full-blown outbreak.

And that’s something that we will discuss later on because it is possible to dampen the effect of a flare.

But for me, I had a major flare. Probably my last major flare was a year and a half ago. I hadn’t had anything go on since then until I was pregnant recently and had a few minor flares due to the hormones.

Let’s also review my ATM’s. My major antecedent is the allergic triad in myself and family members.  As I mentioned above, the allergic triad is allergies, asthma and eczema. Most of that manifests in childhood, but not always. I only had allergies in childhood. Eczema started in my 30’s! If you have any of those, you’re going to be more prone to autoimmunity as an adult.

And, eczema often accompanies other autoimmune conditions, not just in and of itself.

So I have 2 of the allergic triad, and a family history of autoimmunity and inflammation conditions. There’s lots of cardiovascular disease and diabetes in my family. Historically, I was bottle fed and was around smokers growing up which are also key antecedents in developing eczema.

My main trigger was dysbiosis that developed during pregnancy. In the gut, when your hormones such as progesterone are high, it slows things down in pregnancy. It sets the stage for things like leaky gut and dysbiosis to occur. This was something that I had experienced quite a bit of during my pregnancy (even though I tried my hardest to prevent it since I know what I know!!).

Diet was also a key trigger (especially the candy). I kept a clean, organic diet for the most part. However, after the birth, my diet has not been quite as tight. I’m gluten-free and try to be in the realm of Paleo/Autoimmune Paleo. But sometimes I have corn or dairy or beans. And those things have crept into my diet more frequently now that I’ve had the baby.

The candy just happened to be the breaking point for me… that little bit put me over the edge!

My primary mediators are hormone and nutrient imbalances from pregnancy and breastfeeding, leaky gut, and STRESS.

I’m going to reiterate stress here… I’ve got a new baby. I’ve got a 5 year old. I’ve got work. I’ve got life. Everybody’s got stress. But I currently feel like I have a lot on my plate. That’s the main mediator perpetuating the cycle for me.

And for me, stress is probably the number one factor that contributes to my flares every single time. When my stress levels get high, I can get a flare super easily. And I know that’s true for many of the people we work with in the clinic as well.

Another less obvious mediator is lack of sleep. Lack of sleep is a major contributor to manifesting any autoimmune condition, especially something like eczema. We heal and regenerate when we sleep. If you’re not sleeping well, it’s not happening.

Lastly, there’s the issue of support and community, or a lack thereof.  When you first have a baby, everyone comes and sees you for the first couple of weeks. And then it’s suddenly, it’s gone. This can leave you with a sense of feeling like you’re lacking community or lacking support. I won’t say that I feel that tremendously, but I feel it a little bit.

All of these things added up and resulted in my eczema flare.

I got it under control by tightening up my diet, doing some key supplementation, and topical salves.  Thankfully, this prevented it from erupting into a full-blown outbreak.

If you’re looking for more support in healing your eczema and understanding your root causes, you can always book a free 15-minute consult with our clinic:

Do you know you’re root causes or ATM’s? Leave a comment below if you do!

10 Tips to Minimize Healing Frustrations and Time

The truth about healing is that it’s hard and often very frustrating for those going through it. I get questions from my patients on a daily basis about the progress of their healing journey. I refer to it as a journey and not a process because it truly is something that dramatically impacts your life and becomes a part of who you are.  It encompasses serious self-analysis, lifestyle and habit changes, and often therapeutic interventions to change physiology and gene expression. People don’t understand why a certain protocol, lifestyle or dietary change is making them feel worse or isn’t working. That’s when I launch into the discussion about individuality, as well as the difficult truth: healing is hard.

There are a few things that many practitioners don’t like to talk about and a big one is the difficulty of the healing journey. This does patients a disservice because they need to understand that healing takes time, effort, and often a good amount of detective work because finding the root causes can be challenging when they’re buried under years of symptoms and physiological adaptations that have occurred as your body works hard to right the ship to keep it afloat. The body often does a good job of this unbeknownst to you since there are many built in back up processes always aiming to keep you alive and as healthy as possible. However, when the insults become too numerous, changes start to happen. It generally isn’t until the boat has “sprung a leak” that you feel bad enough to do something about it. This process can take years or even decades to develop, so reversing it is hard and often takes years as well. Don’t worry though, healing can and will take place- it just takes time, effort, and perseverance.

There are ways to make the journey easier, saving time, energy, and money. Some of the work regarding diet and lifestyle can be started on your own, but if you have a complex or chronic case, working with someone else will likely save you lots of frustration.

  1. Work with a trained practitioner that understands your case. There is abundant information available on the internet that allows you to research who is the right fit for you, which is very important. Additionally, if the practitioners you’re looking at do free consults or Q&A sessions to see if you’re a good match, take advantage of that.
  2. Doing a complete functional medicine assessment illuminates the journey for the practitioner and the patient. Going back in time starting with pre-birth and pertinent parental history, then walking through birth, childhood, and adulthood in detail allows a timeline to develop that shows major illnesses, exposures, traumas, habits and life events that eventually snowballed into how you feel today. Always tell your practitioner the entire story and truth so you have a complete timeline and don’t need to waste time backtracking once you’re on your healing journey. What may seem insignificant to you, may be of massive importance to your practitioner in uncovering potential causes.
  3. Complete necessary testing to avoid frustration and guessing. Many well intentioned practitioners treat without testing. This isn’t a good idea in chronic cases where the symptoms of conditions are very similar. A good example is with digestive symptoms- diarrhea, gas, and bloating can be cause by many things including SIBO, yeast, parasites, food allergies or intolerances, exposures to toxins, altered microbiome, autoimmunity, etc. Often several of these are occurring simultaneously. Testing allows you to have a more targeted therapeutic plan.
  4. Develop a game plan that works for you and your practitioner. If you don’t think you can handle certain aspects of the treatment plan, let your practitioner know. Most will accommodate your wishes whenever possible- but be honest with yourself. Do you want to alter treatment because you don’t want to do it (such as eliminate foods from your diet) or truly can’t. These are some of the hard truths we have to face when healing. Eliminating foods from your diet and changing your stress response, exercise, and sleeping habits may be challenging at first, but eventually they’ll become habit… it does get easier.
  5. Stick to your guns when temptation strikes. When other people try to sway you away from your healing path, don’t let them. You probably look much better on the outside than you feel on the inside, and they just won’t understand because they’ve never been through it. Sometimes people just flat out ignore what you tell them. Don’t let them ruin what you’ve worked hard for.
  6. Develop strategies for social situations. Hopefully your family understands your journey, but outside the home can be more difficult. If you are going to a social event, preplan and research as much as possible to avoid speedbumps that slow healing. For example, offer to bring some appetizers to the Super Bowl party you’ll be attending so you have something you know is safe for your diet. Additionally, you can make the host aware of your situation and he/she will likely consider you when planning.
  7. Avoid doctor Google. While the internet is an amazing tool for research and empowering yourself, too often people compare themselves to others that were “miraculously cured” by taking a supplement or going on a special protocol. This occurs much less often than you think, and some of these people are leaving out serious details or just plain lying. The truth is that you and every single other person on this planet on genetically and epigenetically different which means you won’t have the same response to supplements, diet, and lifestyle changes. Eliminate your frustration by not comparing yourself to them since you don’t know the details of their history. Also important to note is that on certain sites some of these seemingly honest testimonials come from people that are paid by companies with motives and agendas. The key to healing is doing what is best for YOU (the insert-your-name-here protocol).
  8. Be honest with your practitioner when they ask if you’ve followed the treatment plan. Avoiding the truth will make it more difficult for you and your practitioner to figure out what isn’t working when problems arise (and they will).
  9. Understand that there will be bumps in the road along the path to healing. There is a reason the terms “healing arts” and “practicing medicine” exist- there is no magic pill or protocol that will fix you so as practitioners we must analyze the information and make our best effort to design a treatment plan for you. Since everyone is a unique individual and there’s still so much we don’t know about the human body, it may take some time and effort to find and address all root causes. Additionally, it takes time to change physiology which is imperative to healing. There is often pushback in the form of reactions and additional or increased symptoms while the body adjusts. This is normal and expected, so unfortunately you have to push through it most of the time. If the symptoms last for an extended period or are severe then treatment should be adjusted.
  10. Be kind to yourself during the journey. We are often our worst critics. Don’t beat yourself up over missing a dose of supplements or not getting to bed on time one night. Life happens! Acknowledge the mishap, forgive yourself, forget it and get back on your plan. Stressing will only make the situation worse and prolong your healing.

Following the above can help make your healing journey smoother and also give you an understanding that healing doesn’t occur overnight. The analogy I often use is the healing is a marathon and not a sprint. There are hills and valleys, but in time the road becomes smooth, you hit your stride and things get easier. Eventually you round a corner where you feel good more often than not, which is a good sign that the finish line is near. For some it takes months, but for others it can take years. There is no way to predict how long, but if you’ve felt poorly for years, it may take years to heal. But take heart in knowing that it’s possible since so many before you have.