Psoriasis


Psoriasis is a common autoimmune disease which involves inflammation in the skin, causing a raised, scaly, dry rash.

 
  • Overview
  • Action Plan
  • Ask The Doctor
  • Read & Watch
  • Success Stories
  • See Also

Overview


Psoriasis is one of the most prevalent autoimmune diseases in the U.S., affecting an estimated 3% of the population, and affecting more Caucasians than other races.1

Common symptoms of psoriasis include itchy raised, red patch(es) which may be covered by a dry silvery-white coating. Patches can be found anywhere on the skin, but most common areas include the knees, elbows, lower back, and scalp. Many with psoriasis will experience pitting or crumbling of the finger nails. In some persons, rashes may appear as red, swollen, pus-filled bumps found primarily on the hands and feet. Others with psoriasis may develop arthritis (psoriatic arthritis).

People with psoriasis have been shown to have a higher risk of developing depression, diabetes, heart disease, certain cancers, and obesity.

Scientists are still trying to find the cause of psoriasis, but it is likely a combination of genetic and environmental influences. Investigators believe some of the environmental factors include diet, toxin exposures, and intestinal bacteria imbalance.

 
References
  1. Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol 2014, 70:512-516.

Action Plan


Diet

  • Hundreds of my patients over the last 25 years, have made dramatic recoveries from autoimmune diseases, including rheumatoid arthritis, lupus, connective tissue disease and psoriasis via a Nutritarian diet.  Many have achieved complete recoveries and no longer require any medications.  A vegan and gluten-free diet has shown to be quite helpful for many with autoimmune disease.1,2 Psoriasis and celiac disease seem to be linked, and therefore a gluten-free diet may be helpful.3  
  • Vitamins, minerals carotenoids, flavonoids, fiber, and other phytochemical have anti-inflammatory effects that could help to normalize the immune response and reduce symptoms.3-5 Maximize the intake of immune-system-regulating, anti-inflammatory foods such as green vegetables, mushrooms, onions, squashes, parsnips, turnips and rutabaga, which have low allergic or reaction potential.  Eat both raw and cooked cruciferous vegetables every day. 
  • Anti-inflammatory spices such as turmeric, ginger, cayenne pepper, cloves, garlic, and cinnamon should be used in seasoning dishes.6-9  
  • Avoid alcoholic beverages: Alcohol may act as a trigger or worsen psoriasis symptoms.3 
  • Research suggests that excess sodium may drive autoimmune inflammation.10-12 Minimize added salt. 
  • Identify food triggers to symptoms to reduce or remove (which is individual). Many with autoimmune disease will find they are sensitive to gluten, processed foods, sweets, and animal products. Other foods are less common triggers, such as certain nuts, soy, nightshades, beans, or corn. 
  • Fruit intake may need to be reduced to low or moderate amounts.
  • Talk to your doctor before and after making changes to your diet and supplement regimen if you have a chronic disease or if you are taking any medication, as medication and/or unique dietary modifications may be necessary.  Medication reduction should be monitored by a physician.
  • Meal plan: Autoimmune Reversal

Supplements

  • Dr. Fuhrman’s general supplement protocol for adults (see Vitamin Advisor for details) includes:

  • Additional Supplements:
    • Probiotics:  Research has suggested that healthy bacteria in our intestines may be protective and help to keep a normal functioning immune system. Psoriasis has been associated with alterations in the gut microbiome.14  Eating a fiber-rich diet helps to build up healthy gut bacteria over time, and supplemental probiotics may be helpful, although more research is necessary.15,16  Discuss with your doctor whether taking probiotics is right for you.
    • Omega-3 DHA and EPA: Omega-3 fatty acids provide healthy fats for the skin and have anti-inflammatory effects that may be helpful in psoriasis. Studies in patients with psoriasis have found that omega-3 supplementation led to reduced severity of symptoms.13 High doses may be necessary for the anti-inflammatory effect. If considering high doses of omega-3s, discuss this with your doctor first as it is not appropriate for everyone. .

Read

Other Considerations

Supervised, periodic water fasting can be used as an adjunct treatment for autoimmune conditions. I have documented remission of autoimmune diseases following supervised fasting in a published series of case reports.17 Additional studies have found that fasting (followed by a vegetarian diet) reduces pain in rheumatoid arthritis patients.18,19 Continuing to follow a Nutritarian diet after completing the fast is essential for sustaining the benefits of the fast. Fasting puts the body into a repair mode, facilitating the elimination of damaged molecules, reducing inflammation, and resetting the immune system.20,21 I generally recommend that patients adopt the dietary protocol for a few months prior to considering adding fasting to their protocol. Fasting is not compatible with most medications. Fasting should be done under the supervision of a competent health professional. 

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References
  1. Hafstrom I, Ringertz B, Spangberg A, et al. A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food antigens. Rheumatology (Oxford) 2001, 40:1175-1179. doi: 10.1093/rheumatology/40.10.1175
  2. Alwarith J, Kahleova H, Rembert E, et al. Nutrition Interventions in Rheumatoid Arthritis: The Potential Use of Plant-Based Diets. A Review. Front Nutr 2019, 6:141. doi: 10.3389/fnut.2019.00141
  3. Kanda N, Hoashi T, Saeki H. Nutrition and Psoriasis. Int J Mol Sci 2020, 21. doi: 10.3390/ijms21155405
  4. Katsimbri P, Korakas E, Kountouri A, et al. The Effect of Antioxidant and Anti-Inflammatory Capacity of Diet on Psoriasis and Psoriatic Arthritis Phenotype: Nutrition as Therapeutic Tool? Antioxidants (Basel) 2021, 10. doi: 10.3390/antiox10020157
  5. Yahfoufi N, Alsadi N, Jambi M, Matar C. The Immunomodulatory and Anti-Inflammatory Role of Polyphenols. Nutrients 2018, 10. doi: 10.3390/nu10111618
  6. Mazidi M, Gao HK, Rezaie P, Ferns GA. The effect of ginger supplementation on serum C-reactive protein, lipid profile and glycaemia: a systematic review and meta-analysis. Food Nutr Res 2016, 60:32613. doi: 10.3402/fnr.v60.32613
  7. Zhu C, Yan H, Zheng Y, et al. Impact of Cinnamon Supplementation on cardiometabolic Biomarkers of Inflammation and Oxidative Stress: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Complement Ther Med 2020, 53:102517. doi: 10.1016/j.ctim.2020.102517
  8. Singh S, Aggarwal BB. Activation of transcription factor NF-kappa B is suppressed by curcumin (diferuloylmethane) [corrected]. J Biol Chem 1995, 270:24995-25000. doi:
  9. Aggarwal BB, Yuan W, Li S, Gupta SC. Curcumin-free turmeric exhibits anti-inflammatory and anticancer activities: Identification of novel components of turmeric. Mol Nutr Food Res 2013, 57:1529-1542. doi: 10.1002/mnfr.201200838
  10. Kleinewietfeld M, Manzel A, Titze J, et al. Sodium chloride drives autoimmune disease by the induction of pathogenic T17 cells. Nature 2013. doi: 10.1038/nature11868
  11. Harmon K: Salt linked to autoimmune diseases. In Nature News2013.
  12. Wu C, Yosef N, Thalhamer T, et al. Induction of pathogenic T17 cells by inducible salt-sensing kinase SGK1. Nature 2013. doi: 10.1038/nature11984
  13. Clark CCT, Taghizadeh M, Nahavandi M, Jafarnejad S. Efficacy of omega-3 supplementation in patients with psoriasis: a meta-analysis of randomized controlled trials. Clin Rheumatol 2019, 38:977-988. doi: 10.1007/s10067-019-04456-x
  14. Alesa DI, Alshamrani HM, Alzahrani YA, et al. The role of gut microbiome in the pathogenesis of psoriasis and the therapeutic effects of probiotics. J Family Med Prim Care 2019, 8:3496-3503. doi: 10.4103/jfmpc.jfmpc_709_19
  15. Navarro-Lopez V, Martinez-Andres A, Ramirez-Bosca A, et al. Efficacy and Safety of Oral Administration of a Mixture of Probiotic Strains in Patients with Psoriasis: A Randomized Controlled Clinical Trial. Acta Derm Venereol 2019, 99:1078-1084. doi: 10.2340/00015555-3305
  16. Atabati H, Esmaeili SA, Saburi E, et al. Probiotics with ameliorating effects on the severity of skin inflammation in psoriasis: Evidence from experimental and clinical studies. J Cell Physiol 2020, 235:8925-8937. doi: 10.1002/jcp.29737
  17. Fuhrman J, Sarter B, Calabro DJ. Brief case reports of medically supervised, water-only fasting associated with remission of autoimmune disease. Altern Ther Health Med 2002, 8:112, 110-111. doi:
  18. Muller H, de Toledo FW, Resch KL. Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review. Scand J Rheumatol 2001, 30:1-10. doi:
  19. Smedslund G, Byfuglien MG, Olsen SU, Hagen KB. Effectiveness and safety of dietary interventions for rheumatoid arthritis: a systematic review of randomized controlled trials. J Am Diet Assoc 2010, 110:727-735. doi: 10.1016/j.jada.2010.02.010
  20. Longo VD, Mattson MP. Fasting: molecular mechanisms and clinical applications. Cell Metab 2014, 19:181-192. doi: 10.1016/j.cmet.2013.12.008

Cheng CW, Adams GB, Perin L, et al. Prolonged Fasting Reduces IGF-1/PKA to Promote Hematopoietic-Stem-Cell-Based Regeneration and Reverse Immunosuppression. Cell Stem Cell 2014, 14:810-823. doi: 10.1016/j.stem.2014.04.014

Ask The Doctor


The following are sample questions from the Ask the Doctor Community Platinum and higher members can post their health questions directly to Dr. Fuhrman. (All members can browse questions and answers.)

Q.

I know that you have had substantial success in assisting patients with psoriasis. What I am trying to unravel is whether you take a targeted approach in your prescriptions. Within the general framework of a nutritarian diet, are there certain foods that a person with psoriasis should avoid? In addition, are there certain types of foods (and nutrients) that you recommend a person with psoriasis should consume, and in what quantities? In this context, are there any supplements which you recommend? Is fasting recommended? I strongly suspect there’s a relationship between diet and my psoriasis, but I’m not sure I have the will power for a radical change, however, my psoriasis now is worse than it has ever been -- widespread and very itchy at times -- and I have to tackle it.

A.

It does not take much will-power; it takes knowledge. Once you have the knowledge it seems pretty foolish to suffer with psoriasis. Did you read my book, Super Immunity and the position papers stressing the high-green diet for psoriasis? When you are really committed to get rid of your psoriasis, let me know. You are correct to assume it will necessitate a radical change in your diet. You will have to cut out animal products, coffee, other drinks, and the processed sweets. The mistake you are making is that you think you can't give up your food addictions and won’t enjoy eating a diet without all those compromises. It will take more work, and I know change is stressful, but once you eat this way for a few months you will enjoy it just as much and lose your desire for all the low nutrient junk you are eating. You just have to do it, and you may be surprised that it is easier and tastier than you think. Your fear and hesitation in changing is not based on fact but an emotional response to change.

 
Q.

In the past year I fell off the nutritarian diet and am now trying to once again get psoriasis under control. You had told me in the past that if I gained back the weight the psoriasis would come back. This time it is back with a vengeance and the arthritis too. I am very motivated to change, especially after reading articles on the links between psoriasis and heart attack/stroke risk.

How should I get started...Vitamix? Medicine? Supplements? Gym membership?

I do not wish to lose the use of any more joints and want to stop the inflammation ASAP.

A.

The place to start is 100 percent dietary perfection with no compromises and no excuses (and to exercise every day, no matter what the weather). Instead of medications, juice fast a few days and water fast a few days to curtail inflammation every few weeks. Follow the dietary protocol for autoimmune disease from my Super Immunity book. You do not have to have a gym membership to exercise vigorously. The most important supplement to assure adequacy is Vitamin D. Do not let yourself get deficient in that.

 
Q.

Can pustular psoriasis be reversed with a nutritarian diet? I developed this disease about 8 years ago. I currently eat a SAD diet, I’m about 50 pounds overweight, smoke a few cigarettes a day, and I don’t exercise. I take Soriatane for it. My dad also had it. I’m skeptical that diet will help since I think mine is one of the worst forms of psoriasis and is probably hereditary. I’m currently on antibiotics and steroids for walking pneumonia. I have a terrible cough and am wheezing and out of breath, and my doctors suspect maybe allergies or asthma or perhaps a reaction to my meds are the cause.

A.

Genetics plays a lesser role in all forms of psoriasis (and autoimmune disease in general), but early life environmental and dietary factors are the major contributory factors in those susceptible individuals. Smoking, obesity, and alcohol have been shown to increase the severity of the disease. Infections and exposure to antibiotics can also worsen the course. It takes a strongly motivated person to heal their body via nutritional excellence, and you have multiple addictions going on, so you have to take the initiative to learn more so you have the tools and education to change. Reading my book Super Immunity would be a good start. You would have to be willing to give up cigarettes cold turkey and simultaneously give up your old diet. It is not impossible; I have seen people do it. It might be helpful for you to be seen in the office, since it sounds like you have complex issues and could use the extra motivation. If you follow the protocol carefully, lose weight, and stop smoking, you should benefit greatly.

 
Q.

The autoimmune protocol lists dietary avoidance of salt, wheat, and oil as one of the guidelines. I have psoriasis and have been following this protocol. Currently I avoid wheat and gluten. Is it only wheat that needs to be avoided or all grains with gluten?

A.

You can still eat low gluten grains, such as oatmeal, but most do better with avoiding wheat, rye, and barley.

 
Q.

I have been suffering with seborrheic dermatitis (or psoriasis) on my scalp and in my ears for about 10 years now. I have gone to many dermatologists and have tried every treatment there is, including lotions, creams, different shampoos, etc. I have also tried some natural soaps, shampoos, essential oils, probiotics, etc.

Nothing has really helped. It is very frustrating because I have dandruff, and it looks terrible and it constantly itches. My ears have a white dry layer that shows the minute I stop using the medicated cream.

Do you think this can be eradicated by following a nutritarian diet? Are there any topical products or supplements that might help? Since I would be doing the protocol for skin related issues and not digestion problems, would I avoid oatmeal and all grains, beans, sweet potatoes, and nuts? If so, what do you suggest as energy sources? My confusion comes from not being positive which foods definitely cause the problem.

A.

You should review my autoimmune guidelines in my book, Super Immunity. We frequently see people with psoriasis improve with the autoimmune protocol outlined there. The key features are a strict ETL vegan diet, high dose EPA/DHA (omega 3 fatty acids), no wheat, no dairy, supplemental flora (probiotic), supplemental vitamin D (if levels are low), minimal dried fruit, large salad or blended salads, and a glass of fresh vegetable juice per day. The digestive track is what promotes the immune dysfunction that causes the attack on your skin, which is why the probiotic is often helpful. This protocol eliminates the most likely allergens and is high in the phytonutrients that will heal your immune system. Eat raw nuts and seeds like walnuts, cashews, and sunflower and sesame seeds along with the foods listed in the autoimmune position paper. Start with avoiding gluten for six weeks and any other food that you feel you may be sensitive to.

You need to follow the protocol 100 percent, not 95 percent, to get better, and even then it could take months to see improvement. No snacking on nuts and seeds, just some with the salad or in the salad dressing. Since you relate that your problem is severe, it may be best to have a comprehensive evaluation in our office, with blood work.