rich and poor alike are obsessed with food and eating , and most patients are overly concerned about the diet to follow to cure their illness . diaeta which translates to  a prescribed way of life. the department of dermatology , kasturba medical college ( kmc ) , manipal organized a continuing medical education ( cme ) on diet in dermatology on 3 march 2013 focusing on the following issues : nutritional assessment of dermatology patients , though important in conditions like atopic dermatitis , psoriasis , acute skin failure , is usually neglected . metabolic syndrome is associated with psoriasis , acanthosis nigricans , etc . and hinders early healing . how to diagnose and manage it ? what is the proper diet for obese diabetics with skin problems ? how to maintain adequate protein and energy intake in a child with food allergy ? there is a tendency to prescribe potpourri of fanciful combinations of antioxidants , green tea extract , polyphenols omega fatty acids , etc . , are these really indicated ? what is the role for triglycerides , essential fatty acids ( efa ) and antioxidants ? dr . smitha prabhu , associate professor , department of dermatology started off the cme with an overview of the topic . dermatitis herpetiformis is a disorder where diet has a definitive role in worsening the disease . in other conditions like psoriasis , atopic dermatitis , acne , urticaria , pruritus , and some forms of contact dermatitis , diet has a probable role . food allergy to peanuts , milk , seafood , eggs , and wheat is common in atopic children as well as in urticaria ; whereas evening primrose oil and polyunsaturated fatty acids ( pufa ) are beneficial in atopy . though the role of food is controversial in atopic dermatitis , in suspected cases , diagnostic tests like prick test , skin application food test , oral challenge test , etc . there appears to be no benefit for elimination diet in unselected cases , which may result in malnutrition and growth retardation. a low glycemic diet is found to be beneficial in acne patients . avoidance of proinflammatory fatty acids and high glycemic load helps in many skin disorders like psoriasis and acne , and in maintaining a healthy body mass . gluten , which is a wheat protein implicated in dermatitis herpetiformis is also found to worsen psoriasis . role of food in protein contact dermatitis , flushing , and specific metabolic conditions [ tables 13 ] was discussed . skin signs of obesity and malnutrition are well known , but the subtle skin signs as pointers towards eating disorders like russel 's sign ( callosity on metacarpal head of index finger due to repeated induced vomiting ) and dry skin with lanugo hair of anorexia nervosa may be missed . though the beneficial role of dietary supplements like omega fatty acids and antioxidants in pharmacological amounts has not been conclusively validated , it seems that doctors and nurses believe that dietary supplements may improve their health as 72% doctors and 89% nurses use dietary supplements , at least occasionally . contact dermatitis and food genetic and metabolic conditions and food skin manifestations of common nutritional deficiencies manjula shantaram , professor of department of biochemistry , yenepoya medical college , mangalore , gave a lucid lecture on the various aspects of cholesterol metabolism . cholesterol is essential for our good health by maintaining the intact organization and functioning of the lipid bilayer of most membranes , it is a precursor for bile acids ( which help in digestion of dietary fat ) , steroid hormones which regulate gene expression , and vitamin d. half of the body cholesterol is synthesized by the liver and the rest obtained from food . fifty percent of liver synthesis of cholesterol is blocked when statins are administered . lipoproteins are complexes of lipids and protein and are needed in lipid transport . based on their density they are divided into chylomicrons , very low density lipoproteins ( vldl ) , low density lipoproteins ( ldl ) , and high density lipoprotein ( hdl ) . chylomicrons transport dietary triacylglycerol ( tag ) from intestine to peripheral tissues , vldl transport endogenous tag from liver to peripheral tissue , ldl transport cholesterol from liver to peripheral tissue , and hdl transport cholesterol from peripheral tissue to liver for degradation and excretion . dietary excess fat is packaged into vldl which is taken up by fat cells and converted to fatty acids . the normal values for each of these are standardized . in certain conditions of excess cholesterol and tg , these are deposited as yellowish nodules or plaques in subcutis giving rise to various xanthomas . eruptive xanthomas contain triglycerides , tuberous xanthomas contain triglycerides and cholesterol , and xanthelasmas mainly contain cholesterol and deposition of lipids in cornea gives rise to arcuslipoides . for a healthy heart and body , diet should contain required amounts of fat and cholesterol . dr . m. mukhyaprana prabhu , professor , department of general medicine , kmc , manipal spoke on the metabolic syndrome , which is very relevant to modern life . the term was coined in 2001 for defining a proinflammatory and prothromobotic state that includes hyperglycemia , obesity , elevated blood pressure , and dyslipidemia . obesity pandemic is spreading worldwide and its current overall prevalence is 39.1% with urban citizens being more affected . indians along with chinese and middle eastern population have a higher inherent risk . international diabetes federation ( idf ) international diabetes federation criteria for diagnosis of metabolic syndrome complications of metabolic syndrome are wide and varied , like risk for development of coronary artery disease , increased risk for stroke , nonalcoholic steatohepatitis ( nash ) , obstructive sleep apnea , polycystic ovarian syndrome , various malignancies , hypogonadism , and accelerated ageing . biomarkers for metabolic syndrome include c - reactive protein ( crp ) , interleukin ( il)-6 , tumor necrosis factor ( tnf ) alpha , fibrinogen , plasminogen activator inhibitor , and adiponectin . increased carotid intimal thickness as measured by color doppler and epicardial fat measured by echo correlate with metabolic syndrome . in dermatology , the relationship between psoriasis and metabolic syndrome was first detected in 1973 when the new england journal of medicine reported an increased prevalence of occlusive vascular disease in psoriatic patients . many other studies followed , which confirmed that psoriasis and metabolic syndrome are closely associated and psoriatics have higher risks of myocardial infarction , angina , atherosclerosis , peripheral vascular diseases , and stroke . increased cardiovascular risk in psoriasis may also be due to use of corticosteroids , acitretin , and cyclosporine ; the increased prevalence of obesity and other associated risk factors ; and uncontrolled inflammation leading to endothelial dysfunction and dyslipidemia . management of metabolic syndrome : primary intervention by promotion of healthy lifestyle , increase in exercise and physical activities , decreased consumption of calories and fat , and change in dietary composition is stressed upon . secondary intervention includes lipid lowering agents , hypoglycemic , and antihypertensives tailored to the patient 's suitability . pufa and antioxidants have come up in the radar of health faddists , nutritionists , and the general public alike ; thanks to the awareness created by various health magazines and the media . but are these claims really true ? meenakshi garg , head of the department of dietetics and applied nutrition , manipal university , gave an interesting overview of this subject . efa are those which can not be produced by the human body and include linoleic ( 18 carbon  6 ) and linolenic ( 18 carbon  3 ) fatty acids . the protective role of  6 fa in the body includes proper functioning of nervous system , immune system , skin and eye , prevention of cardiovascular diseases , alleviation of arthritis , and menstrual and muscle pains . 3 fa are anti - inflammatory and help by lowering triglyceride and cholesterol levels , aid in cancer prevention , increased insulin sensitivity , have a protective function in the nervous system and eyes , and inhibit platelet adhesion . efa are structural components of cell membranes and help in their stability and fluidity and are precursors for eicosanoids . skin is the first target for efa deficiency which leads to altered barrier function , disruption in epidermal homeostasis leading to increase in transepidermal water loss ( tewl ) causing xerosis , scaling , erythema , and dermatitis . efa deficiency can be prevented by consuming adequate amount of food rich in omega fatty acids like leafy vegetables , seeds , nuts , grains , sunflower , safflower , corn , soya or cottonseed oil , walnuts , wheat germ , milk , and oily fish . the recommended daily allowance for  6 and  3 fa in an adult is approximately 5 - 10% and 0.6 - 1.2% of total daily calories , respectively . though efa are supposedly helpful in improving skin conditions like psoriasis , atopic dermatitis , and other eczemas as evidenced by some studies , the current consensus is that supplementation much above the recommended dietary allowance ( rda ) levels does not have much benefit and may even lead to adverse effects like increased bleeding tendency , decreased blood pressure , fishy aftertaste , and bloating . some nutritionists claim that  6 to  3 ratio in the diet should be maintained at 5:1 to 10:1 , though emerging studies state that the increased intake of  3 will be more helpful than maintaining the ratio . antioxidants are substances that prevent or delay cell damage by neutralizing harmful free radicles which contain unpaired electrons by donating their electrons and include vitamin c and e , selenium , carotenoids , lycopene , lutein , zeaxanthin , flavonoids , polyphenols , phytoestrogens , etc . , these are abundant in fresh fruits and vegetables . research has not shown artificial antioxidant supplementation to be beneficial in prevention of diseases . moreover , extremely high doses of antioxidants may lead to health problems like diarrhea , bleeding , and toxic reactions . megadoses of vitamins can lead to toxicities like hemorrhage ( vitamin e ) , diarrhea , malignancies , atherosclerosis , renal stones ( vitamin c ) , alopecia , skin rash , fatigue , and central nervous system ( cns ) anomalies ( selenium ) . phytochemicals are found in a variety of plant sources [ table 6 ] and have antioxidant activities . natural sources of phytochemicals she concluded by saying a systematized cochrane review published in 2012 states that  the current evidence does not support the use of antioxidant supplements in patients with various diseases. why do nt antioxidant supplements work ? this may be due to the fact that in the natural state various antioxidants are combined with various other constituents which may help in their efficacy , and difference in the chemical composition in food vs commercial antioxidants influence their effects . for example , vitamin e supplements contain only alpha tocopherol whereas in food , eight chemical forms are present . moreover , antioxidants may be specific for each disease , that is , eyes contain lutein in more amounts , and capsules containing lutein may be more beneficial for conditions like macular degeneration rather than for skin conditions . suvarna hebbar chief dietician , kmc hospital , manipal , focused on the assessment of nutritional status of a dermatological patient . general examination of the patient with focus on specific manifestations of vitamin and mineral deficiency is a must . anthropometric measurements ( weight , height , skin fold thickness , and body mass index ( bmi ) ) measure the current status and do not differentiate between acute and chronic states . waist circumference predicts mortality better than any other anthropometric measurement and is useful in calculation of the waist - hip ratio . these are : 24 h dietary recall , food frequency questionnaire , dietary history since early life , food dairy technique , and observed food consumption . the talk was concluded by a case study which involved the nutritional assessment of an erythrodermic patient and preparation of a sample menu . mrs . garg elaborated upon a model diet plan for patients with metabolic syndrome and skin disease like psoriasis . she stressed upon lifelong commitment towards lifestyle changes like low calorie diet to achieve a healthy bmi of less than 25 kg / m facilitated by healthy eating habits with low intake of saturated and trans - fats and cholesterol , at least 30 min of moderate to intense physical activity on most days of the week , stopping smoking , and alcohol consumption . a healthy weight reduction is 0.5 - 1 kg per week ; more than this being due to water loss rather than to fat loss . regular mean times , avoidance of high calorie snacks and fad diets , and reducing portion sizes were stressed upon [ figure 1 ] . components of therapeutic lifestyle changes ( tlc ) were discussed , which include heart healthy diet , weight reduction , and regular physical activity . principles of diet included restriction of calories , moderate carbohydrate content , high fiber , adequate protein , vitamins , and minerals with restricted fat . strategies for healthy weight reduction the various steps in planning a diet were discussed [ table 7 ] . steps in planning a diet the energy requirement of an individual is based on three factors : basal metabolic rate ( bmr ) , thermic effect of food , and physical activity and is calculated in many ways , a simple chart is given below [ table 8 ] . calorie requirement based on weight the general breakup of calories from macronutrients is as follows : protein-20 - 25% of total calories , fat-20 - 30% , carbohydrates-60 - 65% . table 9 depicts a model for healthy food servings and table 10 denotes a sample diet plan for indians . food servings and their equivalents example of healthy diet plans for a normal person mrs . garg next discussed about glycemic index and glycemic load ; lower the values , lesser the intake of simple sugar . basically , proteins and fats have low glycemic index , whereas simple sugars have higher values . fibers have a protective effect on heart , gastrointestinal tract ( git ) , and pancreas by lowering blood cholesterol , slowing the absorption of glucose , causing slow transit of food through git , softening and bulking up stools , and by causing a feeling of satiety . in patients with hypertension and renal disease , we often advice sodium restriction , which is classified as mild ( 2 - 3 g ) , moderate ( 1 g ) , strict ( 0.5 g ) , or severe ( 0.25 g ) restriction . the beneficial effects of mediterranean diet which uses more of olive oil and red wine in moderation , and the intensity levels of various physical activities were also discussed . moderate physical activity includes brisk walking , swimming , bicycling , playing basketball and volley ball , homecare , and social dancing . finally , the benefits of weight loss were touched upon , that is , boost up in energy , decrease in blood pressure , total cholesterol and blood sugar levels , increase in hdl cholesterol , reduction of depression , insomnia , stress , and prevention of osteoporosis , certain cancers , heart disease and stroke . this talk was of significance as cow 's milk allergy is seen in nearly 7% of all infants and cows milk is the most common antigen to which they are exposed and almost all infant milk formulae are made of cow 's milk protein . milk allergy is more common in obese and those with a higher degree of hygiene practice . parental education , reading of labels of packaged food stuffs before consumption , monitoring of annual growth rate , and monitoring of dietary intake are recommended . prevention of cow 's milk allergy can be achieved by giving babies extensively hydrolyzed formula combined with breast milk and no solid food until 6 months of age and replacing milk with other food alternatives which will give same nutrition to the child . alternatives for milk allergy include extensively hydrolyzed formula , partially hydrolyzed formula , oat milk , almond milk , soya milk , and coconut milk . vitamin a and d and calcium supplementation is advised . even though milk allergy is often  out grown by 5 years , subsequent reintroduction is to be done only under medical advice . proper dietary advice to parents is important as unnecessary deletion of multiple food stuffs are common which can lead to failure to thrive . diagnosis of milk allergy is not straight forward and sometimes requires various tests and detailed diet history , trial elimination diet , and maintenance of a food diary . this one day intense cme concluded with a questions and answers session , wherein there was intense discussion touching upon many aspects of diet in dermatology which hitherto were not much focused upon . indian j dermatol venereol leprol 2010;76:103 - 15basavaraj kh , seemanthini c , rashmi r. diet in dermatology : present perspectives . indian j dermatol venereol leprol 2010;76:103 - 15 basavaraj kh , seemanthini c , rashmi r. diet in dermatology : present perspectives . indian j dermatol venereol leprol 2010;55:205 - 10 various relevant journal and text book articles have been referred by various speakers in preparing their topics .
food is intricately related to mind and body and is one of the elements sustaining life , in disease as well as in health . 
 there are many myths and misgivings regarding partake of food and its medicinal properties . 
 the department of dermatology , kasturba medical college ( kmc ) , manipal organized a continuing medical education ( cme ) on diet in dermatology on 3rd march 2013 focusing on pertinent issues regarding diet and medicinal use of food .