From healthcentral.com
Our guide can help you determine which eats are making your skin better—and worse
Diet alone can’t cure your psoriasis (PsO). (Neither can any medication or therapy, for that matter). However, research suggests that eliminating or adding certain foods may lead to an improvement in those PsO symptoms that flare up now and again—you know the deal: thick, scaly patches or spots on your skin, often accompanied by itching.
Board-certified dermatologist Debra Jaliman, M.D., who has a private practice in New York City and has taught dermatology at Mount Sinai School of Medicine for over 25 years, has seen some of her patients experience changes in their skin after making dietary changes. And Seattle-based registered dietitian nutritionist Ginger Hultin, author of Anti-Inflammatory Diet Meal Prep, also can vouch for the importance of diet in PsO patients. “I’ve actually had a lot of success with my clients having a reduction in psoriasis symptoms through the dietary changes we implement together,” she says. Thinking you could go for some expert advice on how to tweak your diet accordingly? Let’s dig in.
Cut Down on Sugar
Although there’s not a direct link between sugar intake and psoriasis (and research is lacking in this area), studies tell us that eating too much processed food can lead to obesity, metabolic syndrome, and a wide range of chronic health conditions, which in turn can increase inflammation in the body and trigger psoriasis flares.
“Processed food is often high in sugar,” says Hultin. We’re talking crackers, cookies, snacks, pre-made meals—pretty much anything that comes in a package. The good news is that she doesn’t find that her clients have too hard a time reducing or eliminating added sugars in the diet. “It’s good that there’s a specific line on nutrition labels now that indicate ‘added sugars’ so you can easily see how much is coming into your diet,” she says. “I usually start with helping my clients reduce their intake to the American Heart Association levels, which are less than 150 calories/36g of sugar per day for men and less than 100 calories/25g of sugar per day for women, keeping in mind that less is likely better. I often just have everyone aim for less than 25g.” It’s important to know that even natural sugars like honey and maple syrup count toward this number, Hultin adds—so it’s not just processed foods you need to check for sugar content.
Figure Out Whether Dairy Is a Factor
Dairy products like milk, cheese, yogurt, kefir, ice cream, and butter contain a natural sugar called lactose, a protein called casein, and a polyunsaturated fatty acid called arachidonic acid. In some people these ingredients are difficult to digest, says Hultin, but there’s no established link between dairy products and psoriasis. A review published in the Indian Journal of Clinical Dermatology found that the arachidonic acid that’s present in dairy products may aggravate the inside lining of the intestinal tract and make psoriasis symptoms worse, but ultimately the researchers concluded that this link can’t be confirmed without further large-scale studies.
“Dairy isn’t innately pro-inflammatory unless you have an allergy or intolerance to it,” says Hultin. However, she has found that it’s one of the most common psoriasis triggers in her clients, so every now and then she helps those clients with a modified elimination diet (more on that later) to remove dairy.
Work Out if Gluten Is a Trigger
The National Psoriasis Foundation (NPF) says a gluten-free diet may make a significant improvement to your psoriasis symptoms—if you’re sensitive to gluten (a general name for the proteins found in wheat, rye, barley, and triticale, which is a cross between wheat and rye). Like dairy, gluten isn’t inherently pro-inflammatory, however, Hultin has found that gluten is another common trigger food for people with psoriasis. “Since celiac disease (a condition where the body’s immune system attacks its own tissues when gluten is consumed) has some cross-over with psoriasis, I’ll always ask my clients about their discussions and possible testing they are getting with their medical team,” Hultin adds.
The NPF suggests eliminating gluten for a minimum of three months to give the inflammation in your body enough time to calm down. If you’re not sure whether you’ve seen any benefit from cutting out gluten after this time, the NPF suggests adding it back into your diet. Make a record of any flare of symptoms, such as increased itching and joint pain, so that you can let your doctor or dietitian know.
Think About How Nightshades Affect Your Skin
The nightshade family, which includes eggplant, tomato, potato, and bell pepper, has a longstanding connection to psoriasis flares. One of the most commonly reported triggers for psoriasis flare-ups is the consumption of nightshades. Some researchers say this may be due to the presence of solanine, a glycoalkaloid compound that can be toxic to humans in large quantities (don’t worry—it’s almost entirely found in the leaves and stems of these vegetables, not the parts we eat). Additionally, the Global Healthy Living Foundation states that the number of nightshades a person typically eats is simply not enough to cause an inflammatory response.
“Unless someone knows they have an issue with nightshades—which I haven’t come across in my years of practice—it’s a mistake to eliminate wonderfully anti-inflammatory veggies like eggplant, tomato, and bell peppers!” Hultin says. “They all have so much fibre, vitamin C, and unique antioxidants. I never eliminate these foods for my clients unless we’re running a very comprehensive elimination diet.”
Pay More Attention to Soy
Soy and soy oil contain high levels of omega-6 fatty acids, which have been accused of revving up inflammation. However, a review published in Prostaglandins, Leukotrienes & Essential Fatty Acids concluded that the relationship between omega-6 fatty acids and inflammation is complex and not yet properly understood, so much more research is needed.
Like nightshades, Hultin never eliminates soy foods like tofu, miso, and tempeh unless it’s part of a very comprehensive elimination diet. “If anything, I’m usually advising more of these foods for their anti-inflammatory properties,” she says. “Soy foods are rich in protein and unique antioxidants. Plus, plant-based diets low in saturated fat are highly indicated for psoriasis and so including soy protein in addition to more beans and legumes can be a helpful strategy.”
Ask Your R.D. About an Elimination Diet
The way most people narrow down their triggers is by using an elimination diet—cutting out foods one at a time to see if not eating them has an impact on their symptoms, then gradually re-introducing them to see if that triggers psoriasis. There’s a lot of caution around elimination diets in general, whether you have psoriatic disease or not. “There’s no doubt about it—elimination diets are hard and need to be done right,” says Hultin. “It’s critical that you work with a medical professional like a registered dietitian nutritionist so that you do it correctly and don’t let your nutrition take a hit in the process.”
In Hultin’s experience, there is no single elimination diet that works the same for everyone. “I work with each client to determine together the type of elimination diet we’re going to run and what types of foods will be eliminated and then re-introduced for trials,” she explains. “Done correctly and in a structured way in partnership with an experienced, qualified medical professional, an elimination diet can be very powerful and provide clear answers in a relatively short amount of time. You’ll then know if you need to reduce or eliminate a particular type of food—or not!”
Introduce More Anti-Inflammatory Foods
Dr. Jaliman always recommends anti-inflammatory foods to her psoriasis patients who are keen to explore how dietary changes might improve their symptoms. “The omega-3 fatty acids found in fatty fish like salmon, sardines, herring, and mackerel are well known for their anti-inflammatory properties and very beneficial to psoriasis,” she says. This advice is backed up by the American Heart Association, which recommends that everyone—regardless of psoriasis or any other health conditions—eat two servings of fish (particularly fatty fish) per week.
Dr. Jaliman also recommends a Mediterranean diet, which is nutrient-rich and high in foods that may help reduce inflammation in general, such as fish, whole grains, fruits and vegetables, olive oil, and legumes. However, as with all diets, research is limited on how exactly the Mediterranean diet may improve psoriasis symptoms.
In general, an eating plan with a focus on greater quantities of anti-inflammatory foods is a good call for psoriasis patients, says Hultin. “My clients and I work together to adjust their diets to make them generally more plant-based and rich in antioxidant and fibre-rich foods,” she says. “Anti-inflammatory diets are very flexible, so it’s fun to personalize them to create true ‘forever’ diets that you can stick with long-term. For me, it’s all about what you’re adding and maximizing—more fruits, veggies, whole grains, and plant-based proteins—in addition to thinking about anti-inflammatory nutrients in supplement form for people who are interested in that aspect, too.”
The Bottom Line
Your dermatologist might be your first contact for any psoriasis flares, but bringing diet into the picture might mean seeking advice from someone else. “I certainly give food recommendations, but it’s best for patients to see a nutritionist,” Dr. Jaliman says. She also notes that many people need medication for their psoriasis for the best results—confirming that a multifactorial approach to treatment typically works best for this chronic autoimmune disorder.
Remember, what works for another PsO warrior might not work for you. Our bodies are complex, responding to triggers (including all the different foods we eat) in their own unique ways. Also, it’s not only about what you eat—think about what’s in your glass as well. “I’ve had a lot of success with reducing or eliminating alcohol in my client’s diets,” says Hultin. “Many people notice a big difference when they cut it out.”
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