Psoriasis: More Than Just a Skin Disorder
Monday, November 21, 2016
Linda J. Dobberstein, Chiropractor, Board Certified in Clinical Nutrition
Television commercials appear each day touting the power and benefits of biological drugs to modify the challenging disease of psoriasis. Medicine used to think that psoriasis was only a skin disease and that topical skin treatments were sufficient. Recently, researchers have shifted their viewpoint to look at psoriasis as a systemic disease, manifesting with skin plaques and inflammation, but also inflammatory bowel disease, coronary artery disease, heart attacks, diabetes, and obesity. Old school treatment has given way to very powerful and expensive biological drugs to try and modulate the immune system’s flaming attack on the skin. Natural management of the autoimmune inflammation on a deeper level is essential to reclaiming health and restoring vibrant skin.
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Other Disorders Linked with Psoriasis
In order to understand that psoriasis is more than a skin problem, one needs to only look at the assortment of disorders associated with this autoimmune concern. The list includes heart attack, stroke, cardiovascular mortality, obesity, insulin resistance, cholesterol abnormalities, high blood pressure, diabetes, psoriatic arthritis, depression, anxiety, suicides, Crohn’s disease, multiple scelorosis, and T-cell lymphoma. Several studies have suggested that severe psoriasis is an independent risk factor of atherosclerosis, heart attack and stroke. The surprising outcome though is that the risks are greatest in young individuals with severe psoriasis. Patients treated for severe psoriasis are 30 times more likely to experience a major heart attack than melanoma or skin cancer. Massive heart attacks were seen as the highest risk associated with severe psoriasis.
In addition, there is significant concern and increasing information that demonstrates that psoriasis and gut inflammation, like inflammatory bowel disease, are linked together. Psoriasis affects the outer barrier of the body, the skin. Inflammatory bowel disease (IBD) affects the internal barrier, the gut lining. The skin and the gut lining provide a barrier and a connection to and between the inner and outer sides of the body. Both disorders involve a disruption in the barrier and have similarities. Researchers believe IBD and psoriasis similarities occur not only in genetics, but with two immune compounds in particular, T-reg cells and TH17.
T-Regs and TH17 compounds profoundly regulate immune response and are managed by the gut microbiome. When these compounds are out of balance, high levels of TNF-alpha, an inflammation signal, build up, creating skin damage. Modulating these two compounds and TNF-a is a major focus of current medical psoriasis treatment with drugs like eternercept/Enbrel, infliximab/Remicade, and adalimumag/Humira.
T-Regs and TH17 – Friendly Nutrients
T-regs and TH17 cells are highly important mediators pertaining to host defense and homeostasis. It is important to balance T-regs, TH17 and TNF-a in the gut to keep psoriasis and other disorders like inflammatory bowel disease and psoriatic arthritis in check.
There are several key nutrients that regulate TH17 and healthy T-reg function that are critical for psoriasis management. The focus needs to shift to the gut, systemic inflammation and immune modulating compounds management. Key nutrients are vitamin D, vitamin A, probiotics, DHA, and antioxidants.
Vitamin D is perhaps the most researched vitamin for psoriasis. Researchers focus on vitamin D because it is the most critical vitamin for keeping the skin barrier and the gut barrier intact. Vitamin D regulates skin cell turnover and modulates innate and adaptive immunity. Inadequate vitamin D leads to a breakdown in gut and skin barriers, promoting infection and inflammation. Vitamin D, especially through sun exposure or UVB phototherapy to the skin, regulates T-reg cells. Oral consumption of 4000 IU per day is the suggested safe dose to help bring vitamin D3 levels to the desired therapeutic dose in humans. People with autoimmune inflammation and low lab values of vitamin D may need higher doses of 5 -20,000 IU daily until levels normalize. Get your lab levels measured at least once per year, ideally twice per year, to check vitamin D levels. Ideal lab values for vitamin D are between 50-80 ng/ml.
Research shows that vitamin A deficiency can cause T-reg imbalance, which provokes TH1 excess or dominance. Vitamin A and vitamin D may be tightly allied in how they regulate immunity, as their signaling receptors are interconnected. Together vitamins A and D regulate inflammatory compounds and help keep TH1, TH17, and T-reg cells in balance.
Probiotics strains like Lactobacillus casei and Lactobacillus planetarium have been shown to reduce skin inflammation and modulate T-reg function. Much is yet to be explored in this arena. Other compounds in the gut like short chain fatty acids, (SCFAs) are critical regulators of the TH17 response. SCFAs are produced in the gut by consuming fiber.
Dietary Support for Immune Modulation
In addition to specific support for TH17 and T-regs, other dietary factors and insufficient nutrients also play a role in psoriasis and systemic inflammation. Leptin problems and high calorie diets are significant factors. It is important to follow the Five Rules of The Leptin Diet to control leptin signaling. Obesity and metabolic syndrome can worsen or trigger psoriasis, thus it must be addressed with appropriate support.
Lower calorie and nutrient rich diets like the Mediterranean Diet are also found beneficial. Diets rich in omega-3 fish oil were shown to be highly beneficial for psoriasis and other psoriasis related concerns like blood sugar, obesity, autoimmune inflammation, and heart disease. It is important to consume 3 or more grams of omega-3 oils per day. Monounsaturated fatty acids (MUFA), like extra virgin olive oil, are also strongly recommended for alleviating psoriatic inflammation. Individuals with psoriasis who consume the lowest amount of olive oil have more severe psoriasis and a greater progression of the disease. In addition to olive oil, MUFA rich foods include almonds, cashews, pecans, peanuts, macadamias, avocados, and peanut oil.
Several studies demonstrate a high prevalence of gluten intolerance/celiac disease connected with psoriasis. Psoriatic patients with gluten intolerance showed great improvement in skin lesions within six months of eliminating gluten. Gluten consumption activates T-regs in autoimmune disorders and provokes inflammation.
Antioxidants and Skin Repair
Because the disease process itself is associated with high levels of inflammation and oxidative stress, additional support of vitamins, minerals, and antioxidants are required. Low levels of vitamin B12 have been found in psoriasis patients and in one study, added B12 cleared 30% of patient’s skin lesions and stopped 20% of severe itching within a short time. Selenium combined with other antioxidants like coenzyme Q10 and vitamin E were found helpful in improving skin plaques, nail changes, and joint pain in patients with psoriasis. Zinc, an essential mineral for connective tissue and wound healing, is often deficient in psoriasis patients.
Skin health and integrity can also benefit from other important nutrients like squalene, glucosamine, lycopene, green tea extract and grapeseed extract. Many of these compounds help bring balance back to TH1 dominance.
In summary, psoriasis is far more than a simple skin disease or the presence of skin lesions. The immune balance is upset, high levels of inflammation exist, and the barriers of the body (skin and gut) are inflamed, which leads to increased need for nutrition and antioxidants. At the same time, several dietary factors like gluten intolerance, too much omega-6 oils, high fat, high sugar diets worsen the disease process and increase the presence of life-threatening co-morbidities. One must address these concerns as they lead to a high risk of death from other seemingly unrelated disorders, like heart disease and stroke.
The topical focus of psoriasis fails to describe the depth and complexity of autoimmune inflammation. This article is only scratching the surface of psoriasis, but hopefully provides a glimpse into the deeper elements. Taking a biological drug may indeed lessen the skin lesions, but on what level does the drug actually address the underlying issues? Will the drugs replace the need for a nutrient dense, leptin and blood sugar friendly diet that fixes the real health deficiencies? Or make up for the injury triggered by alcohol, high salt, high fat/omega-6 diet, or gluten? Science has yet to find a drug that can do all those things. Only you can change your diet and ensure that your nutritional status is optimal. Be in the driver’s seat for your health. Psoriasis is your skin on fire, but the fire is coming from inside of you. As Smokey the Bear has stated “Only you can prevent a forest fire”.
Vitamin A – This fat soluble vitamin is essential for the gut and skin barrier function and health. Vitamin A rich foods that supply retinol for healthy skin are beef liver, free-range egg yolks, butter and heavy cream from grass fed cows. Plant sources like carrots, kale, and spinach need to be converted into retinol. It takes considerable amounts of plant based carotenoids to equal the retinol amount found in animal sources of food. Individuals with low thyroid function struggle to convert plant based carotenoids to vitamin or diets often lack adequate amounts of vitamin A, thus making supplementation a necessary choice. Vitamin A and vitamin D3 provide powerful immune protection and stability.
Vitamin D – This nutrient is often found deficient in the body. This is especially true if you use sunscreen, work indoors, have darker skin tone, and/or have gut inflammation. Scientists focus on vitamin D for psoriasis with good reason as it is a powerful anti-inflammatory, gene regulator, and immune modulator.
Squalene – Squalene is a type of oil derived from shark liver oil that help bring oxygen to skin. We have found it extremely supportive for many different types of skin concerns and inflammation. It works well with vitamin D, A, and DHA to help skin cells repair.
Omega-3 Oils – DHA and EPA are fish based sources of omega-3 oils required daily. Most American diets severely lack these good oils in the diet, but have too much omega-6 processed vegetable oils in the diet. High levels of autoimmune inflammation may require as 3 grams or more of omega-3 oils per day in order to quench the fire.
Grape Seed Extract – Grape Seed Extract helps support healthy connective tissue, i.e. skin, gut, and other tissues in the body as it is attracted to these structures. Grape Seed Extract is a type of antioxidant, known as a oligomeric proanthocyanidins (OPC’s) that protect against the breakdown of collagen, elastin, and hyaluronic acid. It helps support glutathione in the body making it a versatile antioxidant for the gut, immune system, and skin.
Lycopene – Lycopene is a powerful antioxidant found primarily in red and orange colored fruits and vegetables. It is part of the carotene or carotenoid family. It works synergistically with vitamins A and D for skin and gut protection. It also plays a vital role in antioxidant support for the eyes.
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