Management of Psoriasis through nutrition

Foods in the typical Western Diet

The classic western diet contains foods that have large amounts of fat and sodium, with big portions, high calories and excess sugar and the Western diet is also low in vegetables and fruit. Links between diet and the immune system is becoming of increasing interest, with studies showing higher levels of inflammation resulting from this type of diet (Rakhra et al., 2020).

Classes of inflammatory foods which can add to psoriasis symptoms include:

Alcohol

Gut bacteria can be damaged by alcohol which can lead to inflammation of both the intestines and colon, additionally long term or heavy drinking leads to stress on the liver as it must work harder to develop the chemicals needed to metabolize the alcohol and this can lead to long term inflammation.

Dairy

Dairy is traditionally high in fat and fatty food can increase inflammation in adipose tissue, additionally some people have intolerances to proteins and enzymes found in cow's milk which can lead to chronic gastrointestinal irritation making inflammation worse.

Highly processed

Foods that contain a lot of added sugars such as sweets and fizzy drinks and foods containing refined carbohydrates, which tend to be high in sugar, force the body to carry the excess energy in fat cells and inflame the fat tissue.

Foods with saturated fats and trans fats

Fats are recognized to provoke inflammation in the body by increasing the low-density lipoprotein in the blood and studies suggest that surplus fat in the body and development/worsening of psoriasis (Wesdock, 2023). The typical western diet is also known to be high in these fats (Rakhra et al., 2020).

Gluten

Psoriasis sufferers tend to have higher rates of celiac disease and this links to generally reducing gluten in the diet which can lower cases of psoriasis flare ups (Wesdock, 2023).

Poor nutrition from the western diet impacts the development and advancement of psoriasis via various internal pathways. Psoriasis sufferers often show unbalanced dietary habits and sufferers are associated with insufficient vitamin D and dysbiosis of gut microbiota.

Foods with a beneficial influence

There are foods that can combat inflammation and nutrients that can regulate and possibly alleviate psoriasis via the suppression of inflammatory pathways or induction of regulatory T cells. These foods include short chain fatty acids, polyunsaturated fatty acids, vitamin B12, vitamin D, genistein, selenium, dietary fibres and probiotics (Kanda et al., 2020).

Examples of such include:

Tomatoes

Green leafy vegetables (such as kale and spinach)

Olive oil

Fruit (such as strawberries, cherries, blueberries and oranges)

Nuts and seeds (such as walnuts and almonds)

Fatty fish (such as mackerel, salmon, sardines and tuna) (Werbach, 2020)

Tomatoes

Tomatoes are abundant in the hydrocarbon phytochemical lycopene, belonging to the tetraterpene carotenoid family, and studies show that growing lycopene levels in the blood can lower oxidative stress and enhance the purpose of endothelial cells. Adhesion molecules play a pivotal role in in the infiltration of T cells into psoriasis lesion areas and lycopene inhibits adhesion molecule expression and NF-κB arousal in endothelial cells (Shih et al., 2020). It is also interesting to note that lycopene is more bioavailable from tomato paste than from fresh tomatoes (Gartner et al., 1997).

Green leafy vegetables

Green leafy vegetables, such as kale and spinach protect cells against inflammation as they are packed full of antioxidants (Nazario, 2022). For example, spinach has anti-oxidant and anti-inflammatory properties and contains folate and vitamin A, B, and C, all of which are crucial for skin health (Rasanan et al., 2022), studies show that spinach has both therapeutic and preventative effects and can be effectively used in the treatment of psoriasis (Siddiqui et al., 2019).

Olive oil

Extra virgin olive oil polyphenols and monosaturated fat contents have antioxidant, immunomodulatory and anti-inflammatory properties and in vitro and in vivo studies indicate that these can improve disease symptoms in altered inflammatory responses such as psoriasis by modulating several molecular pathways and acting at both systemic and local levels (Santangelo et al., 2018). Benefits of extra virgin oil are twofold as psoriasis is classed as an autoimmune disease (CDC, 2020) so the immunomodulating properties will play a fundamental role in addition to the anti-inflammatory properties.

Fruit

Fruit such as berries and cherries are high in polyphenols (Nazario, 2022) which play a role in cellular protection against inflammation and oxidative stress (Hussain et al., 2016). Whole fruit are also a fantastic source of dietary fibre such as the fruit fibre pectin, which has a prebiotic effect and promotes a healthy colonic microbiota. Dysbiosis of the colonic microbiota has been associated with chronic inflammatory skin disorders, such as psoriasis, and therefore a healthy colonic microbiota is associated with better immune function and lower systemic inflammation (Dreher, 2018).

Nuts and Seeds

Omega-3 fatty acids limit the spread of the inflammatory process with its intake leading to the formation of hydroxylated metabolites which limit the synthesis of proinflammatory leukotrienes including leukotriene B4, one of the main inflammation mediators (Balbás et al., 2011). Nuts such as walnuts contain high amounts of omega-3 fatty acids (Mayo Clinic, 2022a) and seeds such as flax, chia and pumpkin are sources of these fatty acids too with flax being the richest source of alpha-linolenic acid which is the omega-3 found in plants.

Fatty fish

Fatty fish are the main source of omega-3 fats eicosapentaenoic acid and docosahexaenoic acid (Cleveland Clinic, 2019) which limit the spread of the inflammatory process. Fish such as mackerel, pilchard, salmon, sardine, herring and kipper are recommended in the treatment of psoriasis (Collier et al., 1993) and according to one study psoriasis symptoms improved with the consumption of 6 ounces of fatty fish per week (Nazario, 2022). Not only is fatty fish a main source for omega-3s it is also one of the few foods that is naturally rich in vitamin D3 (HSPH, 2023). Vitamin D deficiency plays a potential role in the pathophysiology of psoriasis and studies have shown proliferation and differentiation of the keratinocytes is impacted by vitamin D where lower levels promote proliferation and higher levels inhibits this (Mahtani and Nair, 2022).

Dietary modifications have shown to have a direct effect on systemic and local levels of inflammation however an overall healthy diet is of more importance than focusing on one or two particular foods or food groups. The National Psoriasis Foundation recommends dietary modifications such as a Gluten free diet, a Heart healthy diet, the Mediterranean diet, an Anti-inflammatory diet and a Weight loss diet (National Psoriasis Foundation, 2022).

Diet Modifications

As psoriasis affects a diverse range of lifestyles specific nutritional advice should be tailored to the individual and made at a comfortable pace, starting slowly and making simple swaps would be the best start (Wescock, 2023). It is also important to consider whether a person is emotional eating, for example, to soothe negative emotions such as stress (Mayo Clinic, 2022b), a driving factor behind the exasperation of psoriasis.

Food supplements

Recommended food supplements for those not ready to make big changes to their diet:

Vitamin D supplement: In addition to higher levels of vitamin D inhibiting proliferation of keratinocytes, vitamin D receptors in the body have been found to induce a high level of resistance in autoimmune diseases, such as psoriasis, which warrants a higher dosage of this vitamin, studies have shown that an increased amount of vitamin D in these situations do not induce toxicity (Mahtani and Nair, 2022).

Omega-3 supplement: For many adding fatty fish to their diet is not an option, simply due to taste preference or, for example, vegetarians and vegans. And, with on average, 38% of UK adults trying to lose weight (Kantar, 2019) many are concerned over the fat content of nuts, making an Omega-3 supplement a must.

In a randomized double-blind placebo-controlled trial observed over 5 years it was shown that vitamin D supplements with marine omega-3 fatty acids lowered the incidence of autoimmune diseases, including psoriasis, by about 22%, in comparison with a placebo. (HSPH, 2023).

Multi vitamin supplement: Leafy green vegetables contain high amounts of vitamin A, B, C, and folate which are all are necessary for skin health (Rasanan et al., 2022), for those whose diet is lacking in these a good multi vitamin supplement containing these vitamins should help.

Pro and Prebiotic supplement: As dysbiosis of gut microbiota is often associated with psoriasis sufferers, adding a probiotic and prebiotic supplement will aid a healthy colonic microbiota which is associated with better immune function and lower systemic inflammation (Dreher, 2018).

Turmeric and Black pepper supplement: Turmeric has been used over the centuries for chronic inflammatory diseases, its constituent curcumin is anti-inflammatory and anti-proliferative and both in vivo and in vitro studies have shown its efficacy as a treatment for psoriasis (Nardo et al., 2018). Teamed with black pepper the bioavailability of curcumin is increased by 2,000 percent (Greger, 2022). Buy my tumeric, frankincense, black pepper, long pepper and ginger capsules here.

Food swaps

For those who are willing to make small changes to their diet simple food swaps can make a big difference. For example, fresh fruit could be eaten in place of pastries and cookies, choosing herbal tea over highly sweetened hot drinks or swapping sugar filled fizzy drinks for water flavoured with fresh fruit, mint or cucumber (Wesdock, 2023) will all have a positive impact on inflammation.

Elimination diet

An elimination diet could prove beneficial in treating psoriasis. Higher rates of celiac disease are known with psoriasis sufferers (Wesdock, 2023) so reducing/eliminating gluten in the diet could lower cases of psoriasis flare ups. In addition, red meat and dairy products contain arachidonic acid and research has shown that by-products of arachidonic acid may play a role in effecting psoriatic lesions (Park et al., 2016) giving reason to try eliminating these foods.

In a patient reported outcomes survey on food elimination positive skin response was shown with eliminating alcohol, junk food, gluten, white flour products and food from the Solanaceae family (Afifi et al., 2017) whilst another study showed an individual elimination diet which takes into account individuals specific allergies, can contribute to the successful resolution of psoriatic skin lesions and also helps stop the progression of the systemic inflammatory process, therefore decreasing the risk of comorbid conditions and improving life quality (Barilo et al., 2022).

The Mediterranean Diet

The Mediterranean diet has been shown to reduce chronic inflammation and studies have highlighted that the Mediterranean diet may slow the progression of psoriasis (Phan et al., 2018). The diet includes all the foods classed as ‘a beneficial influence’ and it has been ranked as one of the number one dietary lifestyles which has demonstrated over decades that it can improve health outcomes (Ford, 2022). For those looking to improve psoriasis with diet the Mediterranean diet is highly recommended.

Other considerations

Water intake plays a vital role in overall health and hydration is vital for flushing out toxins which in turn helps fight inflammation (Arthritis Foundation, 2023), ensuring you are drinking an adequate amount of water should in turn impact symptoms of psoriasis.

Daily diet plays a big part on the amount and severity of outbreaks, with foods in the typical Western diet being highly inflammatory which can contribute to psoriasis symptoms.

By making changes to diet and therefore giving the body the nutrients its needs, local and systemic inflammation can be alleviated, and symptoms of psoriasis can be reduced.

References

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