What factors may promote this initial inflammatory state?
Diet appears to have a significant role in causing the inflammation which underlies psoriasis. Reports of high levels of anti-gluten antibodies in psoriasis sufferers and of improvements in symptoms on gluten-free diets suggest that food intolerances may play a part.
A recent study led by Dr Abrar Quereshi and published in the Archives of Dermatology [1] revealed that women drinking more than 5 beers a week were almost twice as likely to develop psoriasis when compared to women drinking equivalent amounts of wine, low calorieCalories are a measure of the amount of energy in food. Knowing how many calories are in the food we eat allows us to balance… beer or other alcohol. Although there are strong links between alcohol intake and psoriasis, particularly in men [2] , researchers suspected that these women might be reacting to the high amount of glutenGluten is a protein found in the cereals wheat, rye and barley. Obvious sources of gluten in the diet are bread, pasta, breakfast cereals and…, a wheat proteinProteins are large molecules consisting of chains of amino acids. Proteins are essential nutrients for the human body – they are a building block of… in beer, rather than to the alcohol itself.
Yeast is also a common allergenAn allergen is a substance that is foreign to the body and which can cause an allergic reaction in certain people. Pollen is an example…. Of course there are many other foods that you may be sensitive to (such as dairy, eggs or nuts) and a simple test may help to determine whether a food intoleranceFood intolerance is not the same as a food allergy. Food intolerances tend to cause digestive symptoms such as bloating, cramps and diarrhoea, but are… is contributing to your symptoms. If you have hidden food allergies, then eating the offending foods can cause constant irritation of the gut, possibly resulting in increased intestinal permeability, poor nutrient absorption and bacteria / yeast imbalances. This may well underlie inflammation and promote psoriasis.
Consider the following scenarios: As poorly digested food and pathogens slip between the inflamed intestinal cells and enter the blood stream, the body may respond by mounting an immune response against these ‘foreign’ particles – the result: chronic, systemic inflammation perhaps eventually tipping into auto-immunity. Alternatively, poor nutrient absorption may lead to vitamin and mineral deficiencies. Vitamin DWhat it does: Helps maintain strong and healthy bones by retaining calcium. Deficiency Signs: Joint pain or stiffness, backache, tooth decay, muscle cramps, hair loss…. has an immuno-regulatory role and vitamin A plays a part in controlling cell replication. Both of these vitamins are used in psoriasis treatment and are typically applied directly to the skin.
Still focusing on the digestive system Erica White, nutritional therapist, director of Nutrition Help and author of the ‘Beat Candida Cookbook’, has found that candida albicans, a yeast that normally resides in the digestive system, can grow out of control and pass from the gut into the body causing a variety of health problems, including skin conditions such as psoriasis. She finds that an anti-candida diet often relieves psoriasis. My Special Report on How to Beat Candida provides you with all the information you need to tackle a candida overgrowth.
Can the food you eat affect your psoriasis?
When considering the impact of the diet there is more than just possible food intolerances to be aware of. Low energy diets, vegetarian diets and diets rich in fish oils [3] have all been shown to improve psoriasis symptoms. Although the foods eaten are very different, such dietary changes all produce a similar effect in the body and promote the production of anti-inflammatory substances. They do this by changing the ratio of omega-3 and omega-6 fatty acidsOmega-6 fatty acids are considered essential fatty acids – they cannot be made within the body so must be obtained from the diet. Most omega-6… in the diet and ultimately in the body.
Fatty acids come from fats and are essential for healthy skin, nails, even cells. When processed in the body, fatty acids produce products which may promote or inhibit inflammation. This means that by altering your diet and balancing your intake of fatty acids, you could reduce your overall inflammatory status. Read The Fats of Life in the July 2009 newsletter for an in-depth explanation of the important role of fats.
What else may be affecting your psoriasis?
Looking beyond the digestive system, there are other organs that have a role in psoriasis.
The liver is primarily responsible for processing and removing toxins from the body. However, if liver function is below average then these toxins may be excreted via the skin. So when diseases affect the skin, as psoriasis does, it is sensible to consider the processes in the body that deal with detoxification and elimination. My 9-Day Liver Detox Diet is a fantastic way to improve liver function and help your body deal with toxins. The liver is also responsible for processing hormones and removing them from the general circulation.
There is a higher incidence of auto-immune disease in women and, with recent studies reporting that high levels of the hormone oestrogenOestrogen is one of the main female sex hormones…. are associated with increased auto-immunity [4], it’s possible that the sex hormones play a part in psoriasis. You may suspect or know that your hormones are out of balance – particularly if you suffer from PMS, PCOS, endometriosis, fibroids or have already had your levels checked. (Hormone tests can be arranged via your Nutritional Therapist). If so, then you may benefit from exploring ways to balance your hormones so read the Special Report on How To Balance Your Hormones Naturally.
Population studies have also shown that there is a strong genetic component to this disease – immediate relatives have a higher risk of developing psoriasis than the general population [5]. Although it’s impossible to alter your genetic makeup, other lifestyle factors which are known to trigger the disease, such as alcohol, smoking, emotional stress and sunburn, can all be modified. So drinking less, stopping smoking, taking time to relax and reduce stress and protecting your skin from excessive sun exposure are just 4 of the steps that you could take right now. A recent report published in the Archives of Dermatology [6] also identifies an increased incidence of features of metabolic syndrome in psoriasis sufferers when compared to the general population.
Characterised by a combination of obesity, high blood pressure, high total cholesterol and high triglycerides, metabolic syndrome has been associated with an increased risk of cardiovascular disease and diabetes. The study based on 6,549 individuals found that abdominal obesity, high triglycerides and lowered levels of the good HDL cholesterolHDL is short for high density lipoprotein. It is the “good cholesterol” responsible for removing harmful cholesterol from the bloodstream. High HDL levels reduce the… were apparent in over 40% of psoriasis sufferers. Improving these levels would decrease the health risks associated with metabolic syndrome. One way to do this is through a low GL diet. Read my blog Could you be one of the 10 million in Britain who have Metabolic Syndrome?. posted Wednesday June 10 2010, to determine your risk and find out ways to reduce it.
8 steps to improving your psoriasis
Simply put, all these different considerations mean that there are many avenues to explore with the aim of improving your psoriasis.
Here are eight steps you can take to get psoriasis under control:
1. Tune up your immune system: Psoriasis is primarily an autoimmune diseaseYour body’s immune system protects you from disease and infection, but if you have an autoimmune disease your immune system attacks healthy cells in your… with an underlying inflammatory component. For this reason, any attempt to improve psoriasis must consider the immune system, the body’s natural defence mechanism and the instigator of the inflammatory response. The immune system can be divided into two branches: the natural, innate system which uses skin and mucous to provide general defence against invaders and the acquired system which provides targeted defence against specific pathogens (known as antigens). The protective effects of the acquired immune system result from the actions of two types of cell; B cells and T cells. Whereas B cells defend by producing antibodies against antigens (just like the anti-gluten antibodies produced if you are sensitive to gluten), T cells are activated and develop into two types of helper cell: TH1 and TH2.
In psoriasis it is found that the TH1 subset is much more active and that there is a fundamental imbalance in the ratio of TH1 / TH2 activity. So now we have our first goal for improving your psoriasis. Typical treatment includes the use of corticosteroids which suppress the immune system but ideally we want to restore TH1 /TH2 balance. Plant sterolsPlant sterols are compounds similar to cholesterol which occur in plants. They can help to prevent cholesterol being absorbed in the body…., which have a similar structure to steroids, have been shown to effectively balance the immune system [7]. Sterols are naturally abundant in beans, nuts and seeds and are especially concentrated in flax and chia seeds, olive oil, cashew nuts and alfalfa sprouts but your intake will be limited if you regularly eat refined and processed foods or your diet is not varied. You can also supplement a phytosterol complex especially if you don’t like eating these foods.
2. Identify hidden food allergies: Identifying and removing foods that you are intolerant to is one way of interrupting the cycle of digestive irritation, malabsorption, inflammation and immune overactivity. In fact psoriasis patients who are sensitive to gluten have found their symptoms improve when following a gluten-free diet [8]. If you do test positive for any foods, then following an exclusion diet could help determine whether food intolerance is actually contributing to your symptoms. A Food AllergyA food allergy occurs when the body’s immune system reacts abnormally to a specific food as it is perceived as a threat. In the most… test can be arranged through Yorktest Laboratories (www.yorktest.com or telephone 0800 074 6185) or by your Nutritional Therapist.
3. Reduce inflammation: Inappropriate inflammation is an underlying component of psoriasis and your inflammatory status can be directly influenced by the foods you eat. Omega 3 fats, either from vegetable sources (called ALA) or the more potent ones from fish oils (called EPAEPA is short for Eicosapentaenoic Acid. It is an essential omega-3 fatty acid found in fish such as salmon, mackerel and herring, and is often…, DPA and DHADHA is short for Docosahexaenoic Acid. It is an essential omega-3 fatty acid found in fish such as salmon, mackerel and herring, and is often…) are potent anti-inflammatories. Vegetarian diets / low meat diets and diets rich in oily fish (e.g. sardines, pilchards, mackerel, salmon) which supply less of the pro-inflammatory omega 6’s and more of the inflammation-reducing omega-3’s reduce psoriasis symptoms. Supplementing essential fats is one way to ensure that your dietary requirements are met and that you have the correct ratio of omega-3 to omega-6 fats. I take a concentrated mix of EPA, DHA, DPA and GLAGamma Linolenic Acid (GLA) is an essential fatty acid within the omega-6 family. It is found primarily in plant based oils such as evening primrose… (the most potent 0mega 6 fatThere are many different types of fats; polyunsaturated, monounsaturated, hydrogenated, saturated and trans fat. The body requires good fats (polyunsaturated and monounsaturated) in order to…) every day anyway but recommend additional omega 3 in an EPA rich fish oil capsule..
EPA is the most proven anti-inflammatory so look for supplements that have the most EPA. In total, you want about 500mg of EPA a day. Of course strict vegetarians and vegans need a non-fishy source of these beneficial omega-3’s. Eating a tablespoon of chia or flax seeds every day will provide you with a good amount of omega 3 (ALA) but this kind of omega 3 is not nearly as potent as the EPA is fish oil. Also, make sure you eat plenty of antioxidantAntioxidants are substances that protect cells within the body from damage caused by free radicals. They help to strengthen the body’s ability to fight infection… rich fruit and vegetables, and take a multivitamin containing antoxidants. These help protect essential fats from becoming damaged. Consider other anti-inflammatories such as quercetin which is a naturally-occurring flavonoid found in pomegranates, red onions and apples, long-used in traditional medicine that has proven anti-inflammatory actions [9]. While a red onion gives you 20mg supplementing at least ten times this amount is much more effective.
4. Boost your liver detox potential: This hard-working organ is responsible for a multitude of functions – it regulates blood sugar levels, makes cholesterol and hormones, stores vitamins and nutrients and removes old hormones. It is also the site of the two independent detoxification processes which remove toxic substances and help maintain the body’s health. With this many roles no wonder it can occasionally use a little support! While the 9-Day Liver Detox Diet will help detox you and improve your liver’s detoxification potential, there are also detox herbs and nutritional supplements available from HOLFORDirect that work to improve the general function of the liver.
5. Balance your hormones: The hormone oestrogen has been linked to increased auto-immune activity. If you also suffer from conditions such as PMS, endometriosis, fibroids or polycystic breasts or ovaries, then you may need to consider improving your hormonal balance. Since the liver breaks down excess oestrogens improving your liver detox potential helps balance your hormones. To find out if you do have a hormone imbalance, both Oestrogen MetabolismMetabolism is a term that is used to describe the chemical reactions that take place within the body’s cells. The body gets the energy it… Assessment and 1 day ProgesteroneProgesterone is one of the main female sex hormones…. / Oestradiol Test are available from Genova Diagnostics Geneva Diagnostics (tel: +44 (0)20 8336 7750). I recommend arranging these tests through your Nutritional Therapist or switched on doctor since the results need careful interpretation. There are also supplements available at HOLFORDirect that help address hormonal imbalances depending on your results.
6. Up vitamin D – the sunshine vitamin! Synthetically produced Vitamin D3 analogues (e.g. calcipotriol) have traditionally been used in creams and applied directly to the skin [9]. But this vitamin doesn’t just regulate skin cell reproduction and differentiation. It can also modulate immune cell responses and decrease auto-immunity and in a small trial 76% of patients reported an improvement in their symptoms when 1.0μ of vitamin D was supplemented for 6 months [11]. Remember to look for supplements containing cholecalciferol (D3), the active form of vitamin D. These are available in capsules and oil drops from Totally Nourish. Make sure your multivitmain provides at least 10mcg of vitamin D, which is also rich in oily fish. The best source of vitamin D is direct exposure to sunshine. My Special Report Vitamin D – you are almost certainly not getting enough explains how to optimize your intake.
7. Make positive lifestyle changes: Certain lifestyle changes such as reducing alcohol intake, stopping smoking and finding techniques to manage emotional stress [12] have all been associated with a decrease in symptoms. Seek guidance and emotional support, if you feel you need it from a life coach or a psychotherapist.
8. Soothe your skin from the outside: You can feed your skin, not only from the inside with good nutrition, but also on the outside. When skin is studied under the microscope, 2 distinct layers can be seen: the outer, thinner layer of epidermis and the inner, thicker layer of dermis. Epidermal cells are constantly renewed and replaced – it takes about 4 weeks for a new cell to travel to the surface of the epidermis before being sloughed off. However, when psoriasis occurs this whole process is speeded up; the rate of replacement is up to 1000 times faster, old skin cells are no longer shed before new cells appear, resulting in thickening of the skin in certain areas. Which leads to the obvious question – what process governs cell replication and differentiation, why is it going wrong and how can we fix it? The growth and correct development of epidermal cells is a complex process that depends on the interaction between genes and chemical growth factors.
These reactions also require particular nutrients and both vitamin A and vitamin D have been shown to have a specific role in cell differentiation and replication. When applied directly to the skin these vitamins can regulate and normalise cell growth. Environ skincare products are formulated with scientifically proven active ingredients, including Vitamin A and antioxidant vitamins C, E and beta-carotene.
Environ products are available from HOLFORDirect.com or direct from an Environ skin care therapist. See the International Institute for Anti-Ageing to find one near you in the EU. For international enquiries call +27 21 671 1467 or email [email protected] or visit www.environ.co.za. Topical creams that promote skin healing can also be applied to affected areas two to three times a day. Both aloe vera [13] (a 0.5% herbal extract) and capsaicin cream [14] (0.025 to 75%) have been successfully used to improve psoriasis symptoms.
Many thanks to Nina Omotoso for help writing and researching this Special Report.
KEY REFERENCES
1. A.A. Qureshi et al, Alcohol Intake and Risk of Incident Psoriasis in US Women A Prospective Study, Archives of Dermatology. Published online August 16, 2010. doi:10.1001/archdermatol.2010.204
2. K. Poikolainen et al., Alcohol intake: a risk factor for psoriasis in young and middle aged men? BMJ, Vol 300, pp.780–3
3. S.B. Bittiner et al., A double-blind, randomised, placebo-controlled trial of fish oil in psoriasis, Lancet, Vol I, 1988, pp.378–80
4. F. Tanriverdi, et al, The hypothalamic-pituitary-gonadal axis: immune function and autoimmunity, Journal of Endocrinology, Vol 176, 2003, pp.293-304
5. E.M. Farber et al, Natural history of psoriasis in 61 twin pairs, Archives of Dermatology, Vol 109, 1974, pp. 207–211
6. T. J. Love et al, Prevalence of the Metabolic Syndrome in Psoriasis, Archives of Dermatology. Published online April 2011. doi:10.1001/archdermatol.2010.370
7. A. de Jong et al., Metabolic effects of plant sterols and stanols (Review), The Journal of Nutritional Biochemistry, Vol 14(7), 2003, pp.362-369
8. G. Michaëlsson et al., Psoriasis patients with antibodies to gliadin can be improved by a gluten-free diet, British Journal of Dermatology, Vol 142(1), 2000, pp. 44–51
9. A.P. Harrison & R.G. Cooper, Quercetin: health benefits with relevance to TNF-α-linked inflammatory diseases, Journal of Pre-Clinical and Clinical Research, Vol 2 (2), 2008, pp.135-139
10. K. Kragballe, Improvement of psoriasis by a topical vitamin D3 analogue (MC 903) in a double-blind study, Br J Dermatol, Vol 119, pp.223–30
11.S. Morimoto et al., An open study of vitamin D3 treatment in psoriasis vulgaris. Br J Dermatol, Vol 115, 1986, pp.421–9
12.J. Kabat-Zinn et al., Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA), Psychosom Med, Vol 60, 1998, pp.625–32
13. T.A. Syed et al., Management of psoriasis with Aloe vera extract in a hydrophilic cream: A placebo-controlled, double-blind study. Tropical Med Inter Health, Vol 1, 1996, pp.505–9
14. C.N. Ellis et al., A double-blind evaluation of topical capsaicin in pruritic psoriasis, J Am Acad Dermatol, Vol 29, 1993, pp.438–42; J.E. Bernstein et al., Effects of topically applied capsaicin on moderate and severe psoriasis vulgaris. J Am Acad Dermatol, Vol 15, 1986, pp504–7
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