That is a loaded question. I’ve read a lot about both sides of the fervent debate and these are my thoughts.
On the one hand, there are those who swear by the advice of TSW guru Dr. Michael Rapaport, who claims that diet and nutrition have absolutely no bearing on the withdrawal process. TSA/RSS is an iatrogenic condition caused by steroids and the only thing that helps is cessation of use — everything else is superfluous. In the FAQ section of Dr. Rapaport’s website, he explicitly states in response to why cutting out gluten seems to help during TSW: “The process of withdrawal takes months to years and there are so many ups and downs spontaneously that no credit can be given to diets, bath additives, anxiety reduction etc. etc. Any perceived benefit is purely coincidental and not causal.”
On the other hand, there are those who take a more holistic approach to healing from TSA/RSS and insist Dr. Rapaport is wrong — diet does play a crucial role in both speeding up the recovery process and alleviating TSW symptoms. Proponents of this stance point to a couple of things to back up their argument.
1. Diet/nutrition can address Th1/Th2 imbalance
I don’t profess to be an expert on this topic, but essentially, the human body has both T-Helper 1 (Th1) and T-Helper 2 (Th2) immune cells. Th1 is more immune stimulatory while Th2 is more immune deficient, and they need to be in balance for our bodies to be fully healthy. Most people tilt toward one side or the other, and if it tilts too far our immune systems develop issues such as eczema (Th2 dominant) or psoriasis (Th1 dominant).
When our bodies go through TSW, the Th2 dominance we likely already have gets tilted even further to the extreme, which is why we get so much inflammation. Some believe recovering from TSW ultimately means rebalancing the Th1/Th2 imbalance, which means increasing Th1 and/or reducing Th2 in the body. This is where diet and nutrition come in, as there are many foods and supplements that naturally shift the body toward Th1 or Th2. Check out this Self Hacked post for more information.
2. Diet/nutrition can inhibit the release of nitric oxide
Again, no expert on this field, but from what I have read, nitric oxide is the main mediator of TSW symptoms in that its release causes much of the blood vessel dilation and skin damage we see during the process. While generally a good thing for healthy bodies, excess nitric oxide release during TSW has been blamed for everything from the red skin to the body odor to the oozing/weeping. It’s nasty stuff, meaning during the TSW process we should avoid foods that boost nitric oxide (here are some examples) and possibly take supplements to inhibit nitric oxide, such as vitamin B12 (only in Hydroxocobalamin form).
I must say that, after reading arguments from both sides, I tend to side with the “diet matters” crowd. There are plenty of people who insist that diet and nutrition makes zero difference and claim as proof their own recovery without watching what they consume. Others say that TSW is such a harrowing and nightmarish process that we should hold on to any pleasures we have in life, and this means being able to eat whatever we want. But we really can’t know for sure whether their recovery would have been faster or if their symptoms would have been less severe had they followed a stricter diet or taken certain supplements. However, I have personally been on a pretty restrictive diet myself (no gluten, dairy, eggs; low sugar and grains in first few months) and I know I keep second-guessing myself, wondering if I am depriving myself of things I could eat for nothing.
That said, my diet restrictions are not random, as I did have allergy tests done which revealed that I am severely allergic to dairy and eggs and moderately allergic to gluten — at least during this current TSW phase (I had consumed these products without any issues all my life). I just think it is better safe than sorry, as TSW is already so difficult that if I could just make my suffering a little less unbearable or speed up the process then it would be worth a try. Importantly, I am also determined to rid myself of eczema once TSW runs its course, and making these dietary changes to rebalance my body could very well inch my body closer to that goal.
I feel Dr. Rapaport might be right in that TSW simply needs to run its course, and that, all other things being equal, diet might make no difference one way or the other. But the thing is, we are not all made equal, and some of us have pre-existing conditions that caused us to reach for the steroid creams in the first place, such as eczema. And many of us know (or are convinced) that diet and maintaining a healthy gut plays a huge role in keeping eczema at bay. I therefore don’t see the risk in improving your diet during TSW or why people can be so against it. After all, it can only help.
In the end, I say go with whatever makes you most comfortable. Like most things in TSW, I believe there is probably a trade off of some kind. In the case of diet and nutrition, it could very well be speed of recovery/severity of symptoms vs being able to eat what you want.