PSORIASIS AND NUTRITION

If you suffer from psoriasis you would know how helpless it can make you feel.  One of the most basic ways to fight the disease is to regain control of your life through tweaking your diet. In this article I will discuss what is now known about making dietary modifications which can assist in treating psoriasis.

 

But first I would like to admit that despite recent research on the subject, the jury is still out because at the moment there’s limited evidence that supports the notion that diet has any major impact on psoriasis.  However, many people who suffer from the condition are adamant that changing their diets has helped in finding some relief.  However, it goes without saying that losing excess weight and improving the levels of blood sugar and cholesterol is good for you even if it does little for your skin or joints.

 

I’m sure you’re aware that notwithstanding the potential benefits which are associated with changing your diet, there is the potential downside of having to spend time energy and often money on something you might not really enjoy.  This is something for you to consider before deciding on a course of action.  In any event, I recommend that you discuss your different options with your healthcare professional and make sure that you don’t do anything that might actually make things worse.

Generally speaking, there are four main areas you ought to consider before deciding to change your diet:

Weight-loss

 

A 2014 study linked obesity to an increased risk for psoriasis. Researchers found that a higher body mass index (BMI) is linked with an increased risk for developing psoriasis and psoriatic arthritis, as well as an increase in the severity of the disease.  Please note that there is a lot of debate regarding the accuracy of BMI measurement for fatness.

 

The author of the study, said that obesity may provide the nudge that triggers psoriasis in people who are already predisposed to it. The researchers also found that in overweight individuals, losing weight may improve the effectiveness of treatments. Fat cells secrete cytokines, which are proteins that can trigger inflammation, so effectively losing weight is like reducing fuel for the fire.

 

A  United Kingdom based study from the same year also identified a link between weight loss and a decrease in psoriasis severity. This study focused on a "dietary intervention" combined with systemic treatment, including exercise, over the course of 20 weeks.

It became evident that there was a clear correlation between the amount of weight loss and the improvement of psoriasis. Patients who lost more weight experienced a larger improvement in psoriasis. However, even a small amount of weight loss can have a big impact on disease severity.

 

The long-term impact of a dietetic intervention on psoriasis remains to be explored. But the results of this particular study emphasise the importance of weight loss as part of an overall treatment for individuals who suffer from both conditions.

And if this is not enough…

 

As well as the improvement in psoriasis severity indicated by these results, there are numerous other things that might encourage obese patients with psoriasis to lose weight. Psoriasis, especially if severe, is associated with an increased risk of cardiovascular illness and mortality. Weight loss reduces cardiovascular risk factors (e.g. hypertension, diabetes and high cholesterol). In addition, obesity may reduce the healing effect of different medications.

 

We know that fat is an inflammatory tissue, so maintaining a healthy weight—and reducing overall body fat—may result in a reduction in systemic inflammation.  Even more so, there is evidence that this may, in turn, help with improvement in symptoms of psoriasis and psoriatic arthritis.  We all have to eat to survive, so we might as well eat those foods that might benefit our health.

 

Let's get started

 

To help identify what is considered a healthy weight for you, calculate your body mass index (BMI.) You can use this calculator from the UK NHS. 

 

As a rule of thumb, to lose weight, you must burn more calories than you consume. One kilogram equals roughly 7000 calories. If you cut 500 calories a day from your diet, you'll lose a kilogram in about 2 weeks. There is evidence that people who lose weight slowly, up to half a kilogram per week, are more likely to be successful at keeping the weight off. You'll also burn additional calories if you increase your physical activity.

 

You weight-loss plan should include all of the following:

  • Rely heavily on fruits, vegetables, whole grains, and fat-free or low-fat dairy products.  75% of the space on your plate should be covered by vegetables.

  • Consist of lean meats, poultry, fish, beans, eggs, and nuts.

  • Contain foods low in animal based saturated fats, avoid transfats, and limit cholesterol and salt (sodium).

  • Avoid refined sugars and processed foods.

  •  

Some tips to help you lose weight:

  • Before you get started, consult your healthcare professional.

  • Keep a food diary. Writing down everything you eat is critical! Noting how you feel when you eat will help you identify emotional triggers that may cause you to overeat. Emotional eaters tend to overeat.

  • Eat when you're truly hungry rather than when you're tired, anxious or stressed.

  • Plan your meals ahead of time so you make healthy choices. When dining out, if possible, check the menu online and decide what you will order before you sit down. Ask for dressings on the side. Opt for foods that are baked, broiled or steamed as opposed to fried or swimming in creamy sauces. Avoid chips and bread baskets—they add unnecessary calories.

  • Eat slowly. If you eat too fast, you eat more than you need to satisfy your hunger. Your brain needs time to catch up with your stomach.

  • Stay hydrated. People often mistake thirst for hunger.

  • Eat breakfast. If you skip this meal, you'll be starving by lunchtime and it will be more difficult to make healthy choices throughout the day.

  • Find resources to help you keep track of your food choices and nutritional values, and that can offer additional support when you need it.  I recommend MyFitnessPal.com, which offers a searchable database of foods with their nutritional values.

     

     

Improving cardiovascular health

 

Just like heart disease, psoriasis is an inflammatory disease.  Reducing inflammation and improving heart health are vital for people with psoriasis. Here are some suggestions for heart-healthy eating:

  • Eat fish at least twice a week. Three times a week is better.  Cold-water fish (such as albacore tuna, sardines, mackerel, salmon, herring, and lake trout) contain omega-3 fatty acids which are known to reduce inflammation and can help lower your risk of coronary artery disease.

  • Choose lean meats and poultry without skin. Cook them without adding saturated fat or transfats. Baking and broiling are excellent ways to prepare lean meats and poultry.

  • Use fat-free, 1 percent fat, and low-fat dairy products. But make sure they do not contain high levels of sugars.

  • Limit foods containing partially hydrogenated vegetable oils. They contain transfats. For best results cook in cold pressed virgin coconut or red palm oils

  • Aim for less than 1,500 milligrams of sodium per day. Read food labels to see how much sodium you're consuming.

  • Limit alcohol intake. If you have severe psoriasis, you may benefit from excluding alcohol altogether. If you are going to have an occasional drink, the recommendations are: women no more than one drink per day, men no more than two (this refers to statistical average weight of males or females).

  • Keep an eye on your portion sizes. Consider weighing and measuring your food until you get used to appropriate sizes. MyFitnessPal can help you here.

  • Reduce to a minimum the amount of processed and fast food you eat. If you can, eliminate them all together.

 

For more diet and lifestyle recommendations for people with cardiovascular condition, visit the British Heart Foundation website.

Anti-inflammatory

 

Because psoriasis is an inflammatory disease, following an anti-inflammatory diet is likely to be beneficial in helping reduce the associated symptoms.

 

Obviously there is no guarantee and the response to any medical intervention will vary in accordance with the individual circumstances, compliance with the recommendations, and genetics. However, in my experience, most people respond well to dietary and lifestyle modifications aimed at controlling chronic inflammation.

 Foods to avoid because they have been shown to cause or increase inflammation:

  • Fatty red meats

  • Dairy products

  • Processed foods

  • Refined sugars

  • Nightshade vegetables, including potatoes, tomatoes and peppers

 

Foods to include in your diet that have been shown to reduce inflammation:

  • Cold-water fish (see the recommendations above).

  • Flaxseeds, olive oil, pumpkin seeds and walnuts. These are plant based sources of omega-3 fatty acids.

  • Colourful fresh fruits and vegetables. Colour your diet.

 

Nutritious examples include:

  • Carrots

  • Squash and sweet potatoes

  • Spinach

  • Kale and broccoli

  • Blueberries

  • Mangoes

  • Strawberries and figs

     

Gluten-free diet  

 

In my experience, many individuals suffering from psoriasis and/or psoriatic arthritis and who are looking for treatments that does not involve drugs are interested in a gluten-free diets.  Their instincts tell them that these diets are likely to improve their condition.

Many studies have evaluated the benefits of a gluten-free diet for psoriasis. The link between psoriasis and gluten (a complex protein found in wheat, barley and rye and in many processed foods, from lunch meats to salad dressings) is not well understood, but new research estimates that up to 25% of people who have psoriasis may also be sensitive to gluten. Celiac (also spelled coeliac) disease is caused by an intolerance to gluten. A gluten-free diet is the only known treatment for Celiac disease.

 

Several studies suggested that psoriasis and Celiac disease share common genetic and inflammatory pathways. Additional research suggested that having psoriasis about doubles the likelihood of being diagnosed with Celiac disease.

 

As far as I’m aware, to date, there is no published evidence suggesting that avoiding gluten can improve psoriasis in people who do not have Celiac disease– but there is circumstantial evidence from people who have tried the gluten-free diet and are strong advocates of it.

 

If you think that you may have Celiac disease or that you are gluten intolerant, you may be tempted to take initiative to remove gluten from your diet.  But if you want to be certain, you should schedule a blood test to check for the allergy. Consult to your healthcare practitioner for advice on how to start a gluten-free programme.

 

If you eliminate from your diet more than one food at a time, for example, it can be hard to know which food or foods were actually the problem. I recommend you discuss going on an elimination diet with your nutritionist.  Bear in mind that it could take up to 12 weeks for any inflammation to diminish. A nutritionist can also help you make a list of gluten-free foods which will ensure you get the nutrients your body requires.

 

However, keep in mind that it’s possible that gluten isn't contributing to your symptoms, but that the culprit might another food such as dairy, sugar, corn or soy.

 

Following a gluten-free diet requires becoming educated on all the hidden sources of gluten, as well as educating everyone you live with. To avoid all gluten, you must read labels carefully. You must avoid not only wheat but its derivatives as well. Including: durum, graham, kamut, semolina and spelt. The same goes for barley derivatives: malt flavouring and malt vinegar, as well as rye, MSG and soy sauce.  Read labels regularly because manufacturers change ingredients without notice.

 

It is vital to remember that just because a food is labelled wheat-free it doesn't mean it's gluten-free. Just like it doesn’t mean that because a food is labelled gluten-free that it translates to calorie-free. Some manufacturers add sugar, saturated fats and preservatives to their gluten-free offerings to make them taste better, and that adds calories.

 

You may still eat a sensible diet when you're trying to avoid gluten. Gluten-free diets allow you to eat fresh fruits and vegetables. Beef, chicken, fish, lamb, pork and dairy products are also naturally gluten-free. (But be aware of additives.)

 

For individuals with psoriasis who do not suffer from Celiac disease and are not allergic to gluten, giving up gluten might not be ideal. Following a gluten-free diet is a major commitment. It can be difficult to maintain a balanced diet while eliminating the many foods that contain gluten. It's not a step you should take without consulting your nutritionist.

 

The bottom line on gluten is that removing gluten from your diet may help reduce your psoriasis symptoms as well as eliminate digestive problems, but it's only likely to help if gluten is a problem food for you to begin with.

 

Celiac UK provides a list of foods to eat and those to avoid on a gluten-free diet, it may be used as a helpful reference when planning your meals.

Topping up with supplements

 

Studies are yet to show a direct connection between vitamins and dietary supplements and psoriasis. Regardless, many individuals with psoriasis and/or psoriatic arthritis find that adding vitamins and supplements to their diet helps clear their skin and may ease joint pain.

 

Omega-3 fatty acids have been directly linked to decreased inflammation, and psoriasis is an inflammatory disease. Omega-3 fatty acids also seem to have a positive impact on the body's immune system.

There are three types of Omega-3 fatty acids:

  • Alpha-linolenic acid

  • Eicosapentaenoic acid (EPA)

  • Docosahexaenoic acid (DHA)

 

Alpha-linolenic acid is found in some vegetable oils, nuts, seeds and soy foods. EPA and DHA are found in fatty fish and algae. Fish or krill oil is commonly available in capsule form as a supplement. Some individuals with psoriasis show a deficiency of Omega-3 fatty acids and elevations of omega-6 fatty acids, which tend to increase inflammation.

 

The findings of researches on whether Alpha-linolenic acid supplements can help reduce the severity of psoriasis are a mixed bag. More long-term clinical controlled studies are required.

 

Fish or krill oil can thin your blood, so check with your doctor before you start taking it and especially if you are taking Coumadin (warfarin) or any other blood thinners.

 

Vitamin D  based topical ointments have been around and used to treat psoriasis for a long time. Vitamin D is the main active ingredient in two prescription medications – Vectical and Dovonex – that are applied to the skin. Psoriasis increases the growth of the skin's cells. Vitamin D can change the way cells grow and may slow their progress.

 

Research on whether Vitamin D can help alleviate psoriasis symptoms is limited and it includes some evidence that Vitamin D helps counteract the body's response to inflammation associated psoriasis.

 

However, too much Vitamin D can be harmful and may cause serious side effects by raising the calcium level in the blood. Something that can lead to conditions such as kidney stones and possibly gout.  Before you add Vitamin D to your psoriasis diet programme, consult with your healthcare practitioner.

 

The safest source of Vitamin D is food:

  • Cod liver oil

  • Salmon (sockeye)

  • Mackerel

  • Tuna fish canned in water

  • Milk, non-fat, reduced-fat, and whole, Vitamin D-fortified

  • Orange juice fortified with Vitamin D

  • Yogurt fortified with 20 percent of the daily value of Vitamin D

  • Eggs, Vitamin D is found in the egg yolk

  • Swiss cheese

  • Fortified cereals

 

You may also get Vitamin D from 10 minutes of midday exposure to the sun. (Prolonged sun exposure has been linked to aging skin and skin cancer and is not recommended).

 

A simple blood test can tell you whether you're Vitamin D deficient.

 

Glucosamine and chondroitin are over-the-counter dietary supplements that can be taken individually or together. They occur naturally in and around the cells of cartilage in the body.

  • Glucosamine may help in cartilage formation and repair and possibly prevent inflammation.

  • Chondroitin may promote cartilage elasticity and inhibit the breakdown of cartilage.

 

A growing body of research shows that these supplements may slow the progression and reduce the pain of osteoarthritis, a degenerative disease characterised by cartilage deterioration of the joints. However, psoriatic arthritis and osteoarthritis are different forms of arthritis and have different symptoms. Currently there is no evidence to suggest that glucosamine and/or chondroitin supplements effectively reduce symptoms of psoriatic arthritis.

 

Glucosamine contains substances extracted from animal tissue including shrimp, lobster shells and shark cartilage. People who are allergic to shellfish must avoid glucosamine. Children and women who are pregnant or plan to become pregnant should not take these supplements. Glucosamine has been shown to increase blood sugar levels in some individuals with diabetes. If you have diabetes, talk with your healthcare professional before taking glucosamine supplements.

 

Methylsulfonylmethane (MSM) is an organic sulphur-containing compound found in plants, fruits and vegetables. However, it is destroyed when food is processed. The body needs sulphur to maintain healthy connective tissue.

 

MSM can be bought as a dietary supplement. However, to date, there is little scientific evidence that it relieves joint pain or has anti-inflammatory benefits. One study found that MSM improved symptoms of pain and physical function in patients with knee osteoarthritis without major adverse events. More research is needed.

 

Researchers have not found significant evidence that selenium or vitamin B12 improved psoriasis conditions.

The bottom line regarding vitamins and supplements in relation to the treatment of psoriasis and psoriatic arthritis is:

  • Consult your health care professional prior to taking any ‘over the counter’ supplements. Be aware that every substance has a potential to interact with your other medications and treatments.

  • Supplements should never replace medications which where prescribed by your doctor.

  • Purity, quality, strength and composition of vitamins and supplements is not normally regulated and therefore can vary widely among different brands.  Consult with and follow the recommendations of your healthcare practitioner.

  • If you take supplements and experience side effects, stop taking them and consult with your healthcare practitioner.