The GP who cured his psoriasis by cutting out carbs

From inews.co.uk

Psoriasis is a long-term, chronic skin disease that affects about 1.1 million people in the UK. If you are genetically predisposed to it, it can be triggered by anything from a throat infection to a period of stress, leading to itchy, scaly, and often painful patches of skin around the body. It is commonly found on the knees, elbows, trunk and scalp, and can affect your ability to sleep and concentrate.

There are several forms of therapy, including topical ointments, light therapy and injections to help manage psoriasis and slow the growth. However, there is no cure. This means that many with psoriasis, including Dr David Fox, a GP based in Hastings and father of two, find ways to live with the disruptive condition.

But while trying a new way of eating, the 42-year-old GP found that there was another way to manage, and even get rid of, his psoriasis. Here he tells i about how eating low carb has been an enlightening, and skin-clearing, process.

I’ve had psoriasis since I qualified as a GP in 2010 when I was 28. It was a really stressful time for me, which I imagine was a trigger. Once it’s triggered, it can hang around as a long-term condition.

I lived with it on my scalp, arms and legs for a long time. You can keep it covered if it’s on your arms and legs, but psoriasis on the scalp is difficult. Because it was so visible, people would comment and it was a nightmare to manage. You’re constantly flaking as if you’ve got heavy dandruff, it’s sore, and you constantly scratch. I’m not a particularly vain man, but it was very visible when my hair was cut short and would make me uncomfortable.

Obviously, as a GP, I see far worse things than psoriasis, so I wasn’t feeling too sorry for myself. But it can be hard to find manageable treatments. I used steroid-based creams and they were always effective in the short term, but if I stopped using them, the psoriasis would come back – plus, it was hard to use them on my scalp. I didn’t feel my condition was serious enough to take the immunosuppressant drugs – they can be very effective but also risk side effects, including severe infections, as they affect the whole immune system.

I hadn’t really thought about food being a trigger for psoriasis. I knew that alcohol, which is a common psoriasis trigger, was a trigger for me but I didn’t really connect the dots between the problem with alcohol being its carbohydrate content. However last year, out of curiosity and listening to a colleague’s advice, I started following the keto diet. I wasn’t thinking about my psoriasis at all, but I wanted to see if it would make me feel a bit better and healthier.

Avoiding carbs has dramatically improved Dr David Fox’s psoriasis (left) – he has also lost weight and has more energy (Photo: lacaosa/Getty)

There are some doctors who make living a healthy lifestyle their ‘thing’, but I, like a lot of other GPs, didn’t really look after myself. I kept focusing on reducing calories and doing more exercise, eating lots of carbs such as bread and potatoes, always having a pudding and drinking regularly. Eating keto and then low carb was my way of claiming back my health, and it became a major eye-opener to how diet could run the body’s inflammatory system.

Following the keto diet, you keep your carbohydrates down to about 20 grams a day, which shifts your body from a state dependent on burning glucose to one dependent on burning fat. This means your energy source is fat itself, and when they are used as energy, they release ketones. Before going on the diet, I’d have had toast or porridge, a wrap at lunch and pasta or potatoes at dinner; after, I was instead filling up on cheese, meats, eggs, some fish, such as anchovies, and dark green vegetables like kale or broccoli.

It will always lead to weight loss, and people will find that inflammatory conditions will settle because the inflammation can be caused by sugar consumption. But you will also have other potential benefits – I found I had more energy and slept better after a few weeks.

Within a month, my skin became less actively inflamed and then the patches steadily decreased. After 10 months this psoriasis I’d had since 2010 was gone.

Experiencing those benefits definitely makes the diet easier to stick to. But there is some risk to doing keto, especially if you don’t do it properly, so I would not always recommend it without doing proper and thorough research.

While eating keto, I found the need to supplement with zinc and biotin to prevent hair thinning. You won’t notice the effects straight away (as it takes time for your hair to change) but you need to really keep up the right supplementation.

After doing keto for about four months, I’d lost enough weight and felt that I could relax my diet a bit and move onto a low carb version – instead of limiting yourself to 20 grammes of carbs a day, on low carb you’re aiming generally below 90, which is equivalent of one portion in a balanced meal kit such as Gousto. This meant I could reintegrate eating with my family and all the other things you have to sacrifice by eating a diet that’s not suitable for everyone else. During the time I was keto, the only place I could find the right kind of food when out and about was in M&S, shopping from the supermarket’s ‘three for £8’ deli section – that was where I did most of my shopping for work. You have to be very, very organised and plan carefully and that’s not always possible.

Many NHS professionals, and colleagues of mine, are very interested in intermittent fasting and low carb diets. It’s very helpful for people who do shift work and helps them to keep their weight down. There are examples around the UK where they are bringing low carb as an option to their patients who are prediabetic (at the highest risk of developing diabetes) and those with diabetes who aren’t on insulin. I do recommend it to some of my patients – we have started support groups at our practice for diabetics to offer them low carb support, and we’ve had some great progress there.

It is, however, only an option. It overlaps with the movement against ultra-processed foods (UPF) because avoiding UPFs leads to a low carb, low sugar kind of diet. The Mediterranean diet, too, is effectively a low carb diet. And it’s not as extreme or hard to sustain as eating keto. It’s just the framing (‘reduce carbs and reduce sugar’) that seems to be linking all of these things together. That makes it easy for patients to understand and therefore becomes more about common sense. And there are lots of resources out there to make sure what you do is safe. I tend to recommend the Freshwell online resources which are very patient friendly.

I see that period spent doing keto as a period of enlightenment that made me realise what was possible with my diet, and staying low carb is how I sustain it. I feel amazing – my hunger reflex has gone down, I don’t crave sugar, I can eat with my growing family, and my sleep, energy and psoriasis have all improved dramatically. This is how I want to feel all the time.

https://inews.co.uk/inews-lifestyle/gp-cured-psoriasis-cutting-carbs-3053195

Is This Diet a Waste of Time for Psoriasis?

From healthcentral.com

A trendy weight-loss plan might lessen the minutes you spend every day dealing with skin inflammation, but some studies suggest it could make your condition worse

If you have psoriasis, you'll try anything to get your flares under control. After all, you're spending more than an hour a day just trying to get your skin to behave. Naturally, if there was magic food that would fix your condition, you'd eat it for breakfast, lunch, and dinner, right? That's one reason that the keto diet, short for ketogenic, has been spreading by word-of-mouth among psoriasis patients as a possible way to curb flares. The diet, which is high in fat (more than 70% of daily calories) and low in carbohydrates, changes how your body uses energy, burning a chemical made in your liver called ketones (and, by extension, fat) instead of its usual glucose from carbs. It is touted for a myriad of health benefits, not the least of which is its ability to lower inflammation in the body—and that's music to the ears of anyone with psoriasis.

It only makes sense, if you're giving up 60 minutes of your life every day to battle skin inflammation, that you'd sign up for a diet that does it for you. So is the keto diet the timesaver you've been looking for?

The Psoriasis-Keto Connection

It’s a logical leap—but not necessarily the correct one. Last year, a study in the Journal of Investigative Dermatology found that certain fats in the keto diet might actually worsen psoriasis symptoms. In that study, researchers in Austria discovered that while a keto diet that included fats from olive oil, fish, nuts, avocado, and meats didn’t affect skin inflammation, a keto diet focused on using fat from coconut oil, especially when combined with omega-3 fatty acids from fish oil and plant sources (like nuts and seeds), did.

The reason for skin inflammation on the coconut oil-based diet likely has to do with the molecular structure of the fat itself, researchers say. Coconut oil (as well as palm kern oil and to a lesser extent whole milk and butter) is rich in medium-chain triglycerides (MCT), whereas olive oil and avocados, in contrast, are heavy in long-chain triglycerides (LCT).

Your body uses these MCTs and LCTs for energy. Since MCTs are shorter in length than LCTs, they burn faster. But the real issue, as far as your psoriasis goes, is that a diet heavy in MCTs appears to cause the body to produce more damaging pro-inflammatory cytokines, signalling molecules involved in the body’s inflammatory immune response. MCT-rich foods like coconut oil also lead to a build-up of neutrophils, a type of white blood cell that can trigger a psoriasis flare. For reasons scientists are still figuring out, LCTs do not trigger the same response.

A few caveats about the study in Journal of Investigative Dermatology: It’s considered “preclinical” as it was done using lab animals, not humans. Also, the study also didn’t look at a whole foods approach to keto, meaning it didn’t replicate exactly how the diet might be used IRL, says Sarah Brookes, a registered nutritional therapist in London and founder of Autoimmune Hub, a digital network of specialists who work with people with autoimmune conditions.

Still, the results of this study and others suggest that the keto diet might not be the best option for psoriasis patients, Brookes says. She doesn’t recommend the keto diet to her clients—largely because of the plan’s extreme rules. “Eating shouldn’t be such hard work and it shouldn’t socially isolate you either,” says Brookes. “I tend to focus on diets that correct and balance the gut microbiome.”

Psoriasis and Weight Loss

Keto diet or not, if you have psoriasis and you’re overweight (often determined by a BMI of 25-30) or obese (BMI over 30), it’s time to take action. Research has found a link between obesity and inflammation, and carrying extra pounds is both a risk factor for psoriasis and can worsen the existing skin condition, says Sharleen St. Surin-Lord, M.D., a dermatologist and assistant professor of dermatology at Howard University College of Medicine in Washington, D.C.

In addition, psoriasis is associated with cardiovascular disease and metabolic syndrome (which can raise your risk of a heart attack)—two conditions that are also seriously impacted by your weight. Shedding pounds can help reduce your cardiovascular risk with psoriasis, research shows.

And that’s another reason why the keto diet might not be ideal for people with psoriasis: The high-fat diet favours butter and whole-fat dairy products that can raise your LDL cholesterol level, upping your cardiovascular risk. “Since psoriasis also shares a link with other chronic diseases—liver disease, cardiovascular disease—the keto diet may not be appropriate for this population due to its non-heart healthy nutrient profile,” says Amanda A. Kostro Miller, R.D., a registered dietitian in Chicago.

A Psoriasis-Friendly Diet

So, if you want to lose weight to help with your psoriasis and improve your heart health, what should you do? Start by eating a balanced diet that’s low in processed foods, says Dr. St. Surin-Lord.

Brookes agrees. “I would suggest people aim to eat a lot of fruits and vegetables, and eat healthy fats such as oily fish, eggs, avocado, and olives,” she says. “Most importantly, I think people should eat whole foods directly from nature and focus on optimizing digestion and absorption.”

Focusing on what not to eat can be helpful, too. “It’s more of, what do you need to avoid when it comes to psoriasis, because psoriasis is an inflammatory condition,” says Dr. St. Surin-Lord. “You want to avoid inflammatory foods like sugar, red meat, and dairy.”

Keeping a food journal when your psoriasis flares can help you determine if you have particular food sensitivities. “Generally, a diet void of trigger-foods like red meat, dairy, eggs, nightshade vegetables, or gluten is suitable for anyone with psoriasis,” says Tatiana Larionova, a licensed dietitian nutritionist and certified nutrition specialist in Miami, FL.

As for whether or not you should try keto, keep in mind that it may not be the fat itself, but the type of fat, that triggers your skin’s inflammatory reaction. Stick with LCTs like olive oil over MCTs like coconut oil when you’re cooking, and smear your toast with avocado instead of butter. Even then, the keto diet may not be the best option compared to more a personalized, balanced eating plan focused on food sensitivities, Brookes says.

“There isn’t a one-size-fits-all diet, and the ketogenic diet might benefit some people. However, in the case of an autoimmune disease, the key is to heal and rebalance the gut and then personalize the diet,” she says. With a little trial and error—and some thoughtful chats with your derm and dietician—you’ll be able to come up with an eating plan that’s best for you and your skin.

https://www.healthcentral.com/article/psoriasis-keto-diet