Today’s article represents a collaborative effort from my exceptional Kaleigraphy team consisting the comprehensive research by Huda Fareed and the increasingly exceptional writing of Kat Durston.
The piece, which was reviewed for integrity by yours truly, is intended to offer up a glimpse of the state of the evidence around diet, supplementation and psoriasis.
Diet For Psoriasis: What Foods To Eat & Avoid
By Kat Durston with research by Huda Fareed and reviewed by yours truly
Psoriasis is an inflammatory skin disease currently impacting over 125 million people worldwide and is commonly defined by painful rashes and/or patches of red, inflamed skin on various parts of the body.
The occurrence of this unpleasant condition appears to be linked to both genetic and environmental factors and typical treatment modalities include topical creams, ointments, and/or injected steroids.
A growing body of literature highlights the salient connection between what we eat and our skin, and I dive into this connection deeper in many of my other articles including diet + rosacea, eczema + food, & nutrients + skin aging.
After noticing the potentially strong correlation between psoriasis and diet, it was only right that my next skin health venture was on this prevalent topic.
So now you may be asking:
What is the best diet for psoriasis?
That is what I am hoping to address in today’s article on the top dietary management strategies for patients suffering from psoriasis, including what foods to eat & avoid for the most favorable outcomes.
On that note, let’s get into it.
Fish oil is known for its anti-inflammatory properties and therefore has been studied as a potential psoriasis treatment for decades.
This is mostly due to the fact that it contains a high amount of the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are thought to have the ability to reduce inflammatory cytokines.
An example of this was shown in a 2018 randomized trial out of the Scandinavian Journal of Rheumatology where psoriasis patients supplemented with fish oil for 24 weeks and found a significant reduction in inflammatory biomarkers commonly associated with the severity of the condition (leukotriene B4).
Further, a 2019 meta-analysis published in the Journal of Clinical Rheumatology observed an overall statistically significant reduction in psoriasis symptoms such as erythema (skin redness), scaling, and itching with omega-3 supplementation, also noting a greater decrease in symptoms with a higher dose amount across numerous clinical trials.
While there have been few recent trials involving dietary omega-3 intake from fish, adding fish into your diet and considering a fish oil supplement appears to be a low-risk dietary strategy for someone with psoriasis.
Antioxidants are compounds that have the potential to prevent or slow the damage caused by free radicals inside our bodies.
The evidence suggests that a build-up of free radicals inside the body can contribute to psoriasis through the production of inflammatory cytokines as well as DNA modification.
Adding antioxidants into your diet could potentially help combat this damage brought about by free radicals and there are multiple antioxidants that have been examined for their effect on psoriasis including vitamin C, vitamin E, and selenium to name a few.
There have been multiple studies (1,2,3) that have shown specific antioxidant levels in psoriasis patients are potentially linked to disease severity and that a deficiency in these certain antioxidants is associated with psoriasis prevalence.
Additionally, a 2009 randomized trial out of the journal Nutrition saw a significant improvement in psoriasis parameters after supplementing with a combination of antioxidants: vitamin E, selenium, and coenzyme Q10.
Even further, a 2018 trial out of the Indian Journal of Public Health Research and Development concluded a significant decrease in psoriasis symptoms in patients after supplementing with 500 mg of Vitamin C alongside a standard phototherapy treatment.
More trials on the effects of antioxidant consumption on psoriasis are warranted, however, this preliminary evidence appears to support the idea that a diet rich in antioxidants may be a promising approach for psoriasis treatment.
Antioxidant-rich foods include a variety of fruits and vegetables, as well as certain beans, nuts, and dark chocolate.
Curcumin is a polyphenolic compound derived from the spice turmeric and is a top-selling supplement across the globe.
It is currently being studied for its therapeutic ability to treat psoriasis due to a variety of mechanisms including reducing oxidative stress and inhibiting phosphorylase kinase, which is increased in psoriasis patients.
Emerging research classifies psoriasis as a t-cell mediated inflammatory disease and curcumin has been found to interrupt the production of t-cell inflammatory markers that are linked to psoriasis and lead to overall skin improvement.
Although most of the studies on psoriasis and curcumin are in vitro, one 2015 clinical trial out of BioMed Research International saw a significant reduction in psoriasis symptoms after 63 patients supplemented with curcumin alongside topical steroids for 12 weeks.
The impact of our gut microbiome on skin health is not a new concept if you’ve read any of my other articles on inflammatory skin conditions.
Evidence continues to support the relationship often referred to as the “gut-skin” axis and this is highlighted in research on psoriasis treatment as well.
It has been noted that a decrease in skin flora diversity can lead to worsening of psoriasis symptoms, including an increased risk for psoriatic arthritis.
This was also shown in a 2016 case-control study that found psoriasis patients have an increase of gut microbiome species known to induce inflammation (firmicutes) and a decrease in species that counteract inflammation (Bacteroidetes and Actinobacterial).
To help counteract this and increase gut microbe diversity, it is often recommended for psoriasis patients to alter their microbiome through dietary interventions that may support a healthy gut, such as probiotic and prebiotic therapies.
Showcasing this, a 2019 randomized controlled trial concluded that 67% of patients saw at least a 75% reduction in psoriasis severity after 12 weeks of supplementing with a probiotic mixture.
Probiotic-rich foods include sauerkraut, yogurt and kimchi, while prebiotic-rich foods include garlic, onions, leeks, apples, oatmeal,and asparagus.
Foods To Avoid
When considering what foods to avoid with psoriasis, “food triggers” i.e. foods that have been anecdotally noted for exacerbating psoriasis symptoms would seemingly be a logical place to start.
A 2017 US national survey of psoriasis patients published in the Journal of Dermatology and Therapy found the following foods to be common food triggers for psoriasis: sugar (13.8%), alcohol (13.6%), tomato (7.4%), gluten (7.2%), and dairy (6%).
Out of all the food triggers, alcohol appears to have the strongest correlation, with evidence suggesting that two to three alcoholic drinks a week has been linked to the onset of psoriasis, as well as an increase in psoriasis activity and a decreased response to psoriasis treatment.
Another note-worthy diet modification is lowering your intake of red meat and eggs which contain an omega-6 fatty acid called arachidonic acid, a known precursor for the inflammatory marker leukotriene B4 that has been shown to potentially aggravate psoriasis.
However, due to a weak amount of evidence surrounding psoriasis and food triggers, I do not recommend cutting whole food groups out of your diet unless you are personally seeing direct relief or the advice is in conjunction with your medical provider.
The information I have presented today only begins to scratch the surface of the potential impact diet may have on psoriasis and its unpleasant symptoms.
I am confident that evidence will continue to emerge about the connection between what we eat and our skin, and in the meantime implementing a few of these dietary habits into your daily routine is a great place to start.
You also aren’t in this alone- I encourage you to seek the guidance of a registered dietitian like Andy to help you fight back with food.