Psoriasis is an autoimmune disorder that leads to the build of skin cells, which causes scaling on the skin surface. These scales are usually whitish-sliver and develop in red, thick patches. At times, they may crack and bleed also. In general, skin cells grow and slowly rise to the surface and eventually fall off and this typical life cycle takes a month but in people with psoriasis, the production process may occur in just a few days and skin cells don’t get time to fall off. This overproduction leads to the build of skin cells and thus red, inflamed patches.
It is also associated with many comorbidities including cardiometabolic disease, psoriatic arthritis, gastrointestinal disorders, and psychological stress. Various therapies exist for the disease like topical agents, oral medications, and phototherapy. Studies have also shown that patients with psoriasis are more inclined toward dietary interventions as it is more natural and safer. The medical board of the National Psoriasis Foundation has made some evidence-based dietary recommendations for the patients that can help them to prevent the inflammation.
Recommendation 1 – Gluten-Free Diet and Psoriasis
Psoriasis is generally associated with an increased risk of other autoimmune disorders like Celiac disease. It is characterized by an inflammatory response of the small intestine to gluten (present in wheat for example). As per evidence, patients with psoriasis with confirmed celiac disease are recommended a gluten-free diet which helps them to reduce both gastrointestinal symptoms and psoriasis severity.
But only patients confirmed with the markers for gluten sensitivity should be given a gluten-free diet and not everyone. Get the tests done to confirm the sensitivity if patients show active gastrointestinal symptoms.
Recommendation 2 – Weight Reduction and Psoriasis
There is a strong link between __ and psoriasis. Excess body weight is linked with increased psoriasis incidence, increased severity, and reduced response to pharmacotherapy. These associations are thought to be mediated by the proinflammatory effects of increased body fat. As per the literature, a hypocaloric diet to reduce weight has proven to be effective in reducing the psoriasis severity and dermatology quality of life.
Further studies need to be done to assess whether it’s the type of diet that benefits the patients or is it the overall weight loss that is helping and also how much weight loss is needed to see the clinical response.
Recommendation 3 – Supplements and Psoriasis
- Polyunsaturated Fatty Acids
Polyunsaturated fatty acids (PUFA), including omega 3 and omega 6 are thought to be effective in reducing the inflammation in psoriatic patients but several studies done on oral supplementation of fish oil (source of PUFA) were shown to be ineffective in the management of psoriasis symptoms. Even the intravenous fish oil supplementation is not proven to be effective in the management. So, the consumption of fish oil is not recommended for patients with psoriasis.
- Vitamin D
The topical application of Vitamin D is proven to be an effective treatment modality in psoriasis but the efficacy of oral supplementation of Vitamin D is not yet certain. Vit D deficiency is common among patients with psoriasis and lower levels may lead to severe symptoms also but no studies have shown the effective results of Vitamin D supplementation on psoriasis activity in vitamin d-deficient patients. So, Vitamin D supplementation for the prevention or treatment of psoriasis is not yet recommended.
- Selenium
It is an essential nutrient that affects the immune system and decreases selenium levels can be seen in patients with psoriasis. Based on current literature, selenium supplementation provides benefits to a certain type of psoriasis i.e. erythrodermic psoriasis but that study was also done on a small group (n=28). There is no concrete evidence to show that selenium used as an adjunctive therapy can be used as an effective supplement to treat psoriasis. So, it is not recommended.
Recommendation 4 – Specific foods and Psoriasis
As per the limited literature and studies, the Mediterranean diet has proven to be effective in managing the severity of psoriasis. It is recommended to include extra virgin oil in the diet for cooking along with at least 2 servings of vegetables and 3 servings of fruits daily. Also include legumes 3 times weekly with fish or seafood.
Conclusion
These recommendations are based on evidence-based studies. It is important to note that pharmacotherapy is to be continued along with diet intervention and these diet recommendations not only help to improve the severity of psoriasis but can also help to prevent the associated comorbidities by impacting the general well-being of the patients.
Reference list
- Ford, A.R., Siegel, M., Bagel, J., Cordoro, K.M., Garg, A., Gottlieb, A., Green, L.J., Gudjonsson, J.E., Koo, J., Lebwohl, M., Liao, W., Mandelin, A.M., Markenson, J.A., Mehta, N., Merola, J.F., Prussick, R., Ryan, C., Schwartzman, S., Siegel, E.L. and Voorhees, A.S.V. (2018). Dietary Recommendations for Adults With Psoriasis or Psoriatic Arthritis From the Medical Board of the National Psoriasis Foundation: A Systematic Review. JAMA Dermatology, [online] 154(8), pp.934–950. doi:10.1001/jamadermatol.2018.1412.
