Food and environmental sensitivity testing—IgE and IgG4Psoriasis is a chronic skin rash characterized by scaling, patchy, or silvery-looking skin. It has a cyclic nature, flaring up and simmering down. It can affect just knees, elbows, or scalp or can spread over most of the body. It often occurs at the site of a previous injury. Psoriasis often runs in families and usually develops gradually. It affects about 1 percent of the American population as a whole (4.5 million) but 2 to 4 percent of Caucasians.
Psoriasis occurs when skin cells mature too quickly. Skin cells build up on the surface, causing red, scaly patches that often itch or are uncomfortable. Psoriasis flares up because of stress, severe sunburn, irritation, skin creams, antimalarial therapy, or withdrawal from cortisone, or it can be brought on by other triggers. People with psoriasis have an excess of T-helper cell (Th-1) inflammatory cytokines and relatively few Th-2 cytokines. One of the new theories about psoriasis is that superantigens trigger the disease. These prime the T cells to produce high amounts of inflammatory cytokines. These superantigens also contribute to leaky gut, which allows greater exposure to antigens or toxins, including microbial factors. Subsequently these can be deposited along basement membrane in the skin. Immune complexes develop. It’s believed that there is a molecular mimicry between H. pylori antigens and keratin 17, which may cause keratin to proliferate. Keratin is the tough, fibrous protein component of skin, hair, and nails. So when we produce a lot more keratin, the skin gets tough and fibrous. If we look at the DIGIN section of the book, all of these factors play a role: leaky gut, dysbiosis, inflammation, and antigens.
Psoriasis can also occur with joint inflammation as psoriatic arthritis (see Chapter 26), and joint inflammation is found in 3 to 7 percent of people with psoriasis. It isn’t clear whether psoriasis and psoriatic arthritis are the same disease or two almost identical diseases.
Thirty-six percent of people with psoriasis have one or more family members with psoriasis, which suggests a genetic component. Psoriasis is also influenced by insulin resistance, impaired glucose tolerance, obesity, liver disease, and high cholesterol and/or triglycerides. It’s thought to be an indicator of risk for atherosclerosis and may be an early warning sign.
Digestive issues in psoriasis have been found in many cases. There is a clear relationship between celiac, gluten sensitivity, Crohn’s disease, and psoriasis. In psoriasis and these other conditions, researchers found increased intestinal permeability and microscopic bowel lesions. Some people with psoriasis also have gastritis, duodenitis, celiac disease, or inflammatory bowel disease. Disturbances in pancreatic function and even acute pancreatitis have been found to be prevalent in people with psoriasis.
Drs. Michael Murray and Joseph Pizzorno note a number of factors that influence the progression of psoriasis, including incomplete digestion of protein, bowel toxemia, food sensitivities, poor liver function, reaction to alcoholic beverages, and eating high amounts of animal fats.
When protein digestion is incomplete or proteins are poorly absorbed, bacteria can break them down and produce toxic substances. One group of these toxins is called polyamines, which have been found to be higher in people with psoriasis than in the average population. Polyamines contribute to psoriasis by blocking production of cyclic AMP. Vitamin A and goldenseal inhibit the formation of polyamines. Because protein digestion begins in the stomach, low levels of hydrochloric acid there can also cause incomplete protein digestion. Digestive enzymes and/or hydrochloric acid supplementation aid protein digestion. (See Chapter 3.)
Poor liver function may contribute to psoriasis as well. Liver function profile tests and the metabolic screening questionnaire can help you determine liver function, and the metabolic screening questionnaire can also be used to follow your progress. Incorporate a detoxification program with an elimination-provocation diet to determine which foods may trigger your psoriasis. (See Chapters 15 and 18.)
Alcohol consumption contributes to psoriasis because alcohol contains many toxic substances, which stress an overburdened liver. Alcohol also increases intestinal permeability.
Many studies hypothesize that there is a microbe or pathogen that triggers psoriasis. H. pylori has been found in some people with psoriasis. When treated, some people have had large improvements, while there has been no benefit in others. Studies on dysbiosis in psoriasis are lacking. Dr. Zhan Gao and colleagues extracted DNA from skin lesions of six people with psoriasis. He found increased levels of Firmicutes and low levels of Actinobacteria and Propionibacterium species in people with psoriasis compared to controls. Dr. Luciana C. Paulino and colleagues found no significant differences in yeast levels in healthy skin and psoriasis skin.
In a recent study, 21 out of 34 people with psoriasis were found to have Candida albicans in the spaces between their fingers or toes, and the majority were also affected by fungi from the tinea family. Other research found a 56 percent increase in nail fungus in people with psoriasis. Another study looked at stool samples of people with psoriasis and other skin disorders. Researchers found a high number of disease-producing microbes, predominantly yeasts, in the colon. This may not be the cause of psoriasis but rather an indication of poor gut ecology. Treatment for yeast infection corresponded with a decrease in skin inflammation.
Studies on fasting, vegetarian diets, and diets rich in fish oils have all been shown to produce benefit in people with psoriasis. All of these diets reduce inflammation.
Although I have not seen studies on elimination diet, people with psoriasis have high levels of IgE antibodies, which indicates an allergic component. An elimination diet makes sense to try. Allergy and food sensitivity testing could be helpful in figuring out how someone may benefit the most.
Sixteen percent of people with psoriasis have antibodies to gliadin, the protein found in wheat, rye, and barley. However, when tested for gliadin intolerance, their endomysium antibodies were normal. Nonetheless, a gluten-free diet for three months greatly improved the psoriasis. A follow-up study discovered high levels of tissue transglutaminase antibodies in the skin of people with psoriasis. This decreased by half after a three- to six-month gluten-free trial.
The causes and treatments of psoriasis are complex. Successful treatment must encompass several approaches reflecting its complexity. Look for underlying causes and develop a personal program based on your needs.
Food and environmental sensitivity testing—IgE and IgG4
Celiac testing
Candida testing (either blood or stool)
Organic acid testing
Liver function profile
Intestinal permeability testing
Blood testing for vitamin and mineral status
Fatty acid testing
Try an elimination-provocation diet. Explore the relationship between your psoriasis and food and environmental sensitivities through laboratory testing and the elimination-provocation diet. For best results work with a nutritionist or physician who is familiar with food sensitivity protocols.
Take a multivitamin with minerals. Take a good-quality multivitamin with minerals every day. Look for a supplement that contains at least 25,000 IU vitamin A, 400 IU vitamin D, 400 IU vitamin E, 800 mcg folic acid, 200 mcg selenium, 200 mcg chromium, and 25 to 50 mg zinc. Each of these nutrients has been shown to be deficient in people with psoriasis. There are several vitamin A topical creams used by dermatologists for psoriasis. Vitamin A is a critical nutrient for healthy skin.
Try antioxidant nutrients. CoQ10, selenium, and vitamin E supplements have shown benefit. One group reported improvement from use of CoQ10 at 50 mg, vitamin E at 50 mg, and selenium at 48 mcg dissolved in soy lecithin for 30 to 35 days.
Increase consumption of beneficial fats and oils. The research on fish oils is mixed. Eating fish or taking fish oils has been shown to have an anti-inflammatory effect on psoriasis for some people. Fatty acids contribute to healthy skin, hair, and nails, and fish oils promote production of anti-inflammatory prostaglandins. It is also possible that fish oils increase the activity of vitamin D and sunlight. Eat cold-water fish—salmon, halibut, mackerel, sardines, tuna, and herring—two to four times per week or take EPA/DHA capsules along with a balance of omega-6 fatty acids such as evening primrose oil, borage oil, or black currant seed oil.
Enjoy some sunlight and get your vitamin D. Sunlight stimulates our bodies to manufacture vitamin D, which has been shown to be an effective treatment for psoriasis. Ask your doctor to test your vitamin D levels. If low, supplement. Cod liver oil is a good source of vitamin D because it also contains fish oil and vitamin A, both of benefit in psoriasis. In general, slow tanning improves psoriasis, with sunshine and sunlamps prescribed as part of standard therapy. Get your vitamin D levels tested. Normal levels are between 32 and 100 ng/ml. Many integrative clinicians consider levels of 60 to 100 ng/ml to be optimal for people with autoimmune illnesses. Dosage depends on levels. For maintenance, take 2,000 IU of D3 daily. If deficient, then take 5,000 to 10,000 IU of D3 daily for 8 to 12 weeks, and then retest.
A recent study done in Israel at the Dead Sea, long renowned for its treatment of psoriasis, showed that natural sunlight stimulated significant improvement in disease activity. One group was given just sunlight therapy, and the other received additional therapy in mud packs and sulfur baths. Both groups showed significant improvement in skin symptoms and with psoriatic arthritis, where present. Sunlight and ultraviolet light therapy are regular therapies for psoriasis.
Take zinc supplements and/or eat zinc-rich foods. Many studies have determined that people with psoriasis have lower levels of zinc than people in control groups. However, studies using oral zinc supplementation haven’t always shown a clear improvement in psoriasis, though such studies have been of short duration—only 6 to 10 weeks. Even though they didn’t show improvement in the skin, they did show improvement in immune function and dramatic improvement in joint symptoms. It’s possible that either zinc needs to be used along with other nutrients, or the time frame of these studies was too brief to see improvement. Take 50 mg zinc daily.
Try chondroitin sulfate. Several studies have reported improvement in psoriasis in people taking chondroitin sulfate. Take 800 mg daily. Continue at least two months to see if this is effective for you.
Try milk thistle (silymarin). Extracts of the herb milk thistle have been used since the 15th century for ailments of the liver and gallbladder. Milk thistle, also known as silymarin, contains anti-inflammatory flavonoid complexes that promote the flow of bile and help tone the spleen, gallbladder, and liver. An excellent liver detoxifier, milk thistle has also been shown to have a positive effect on psoriasis. Take three to six capsules of 175 mg standardized 80 percent milk thistle extract daily with water before meals.
Try Honduran sarsaparilla. Sarsaparilla, a flavoring in root beers and confections, has proven to be effective in treating psoriasis, especially the more chronic, large-plaque-forming type. Sarsaparilla binds bacterial endotoxins. Take 2 to 4 teaspoons liquid extract daily, or 250 to 500 mg solid extract daily.
Try lecithin and phosphatidylcholine. Lecithin was used in a 10-year study from 1940 to 1950. People consumed 4 to 8 tablespoons of lecithin daily, along with small amounts of vitamins A, B1, B2, B5, B6, and D, thyroid and liver preparations, and creams. Out of 155 patients, 118 people responded positively. Lecithin-rich foods include soybeans, wheat germ, nuts, seeds, whole grains, eggs, and oils from soy, nuts, and seeds. Lecithin granules can be purchased in health-food stores and added to foods as a cooking ingredient. Lecithin can also be purchased in capsule form, as can the active ingredient in lecithin, phosphatidylcholine. Take 4 to 8 tablespoons of lecithin daily or one to four capsules of phosphatidylcholine daily.
Try high-dose folic acid. There is much research on folate deficiency caused by the drug methotrexate, which is a folate antagonist medication often used for psoriasis. This seems ironic, because folic acid is one of the primary nutrients needed for proper skin formation. Jonathan Wright, M.D., recommends extremely high-dose folic acid therapy for psoriasis—50 to 100 mg daily. Alan Gaby, M.D., reports on a study of seven people with long-standing psoriasis. They were given 20 mg of folic acid four times daily. Improvements were seen in three to six months of beginning this regimen. Dr. Gaby warns that this is not a good plan for people who have taken methotrexate because it may cause adverse reactions. Be aware that if folic acid is taken by someone with a vitamin B12 deficiency, nerve damage can go undetected. If you are going to use high levels of folic acid, have your doctor test your vitamin B12 status with serum B12, or more accurately methylmalonic acid testing. I also wonder if the same results could be obtained by using a more absorbable form of folic acid, such as methyl-tetrahydrofolate at lower doses.
Take selenium. Many studies have shown that people with psoriasis are deficient in selenium. Selenium is part of a molecule called glutathione peroxidase, which protects against oxidative damage (free radicals). Giving supplemental selenium to people with psoriasis showed an increase in glutathione peroxidase levels and improvement in immune function, though not an improvement in skin condition. However, these were studies of short duration with selenium as the only supplement. This underscores the concepts of patience when using natural therapies and of using more than one nutrient or approach at a time. Take 200 mcg daily, which you can get in a good multivitamin. Selenium can be toxic, so more is not necessarily better. Brazil nuts are an excellent source of selenium. Eat one to two daily to get 200 mcg.
Try Saccharomyces boulardii. Saccharomyces boulardii is a cousin to baker’s yeast. It has been shown to raise levels of secretory IgA, which are low in psoriatic arthritis and psoriasis. Take three to six capsules daily.
Use aloe vera cream. A placebo-controlled study of 60 people with psoriasis found that a 0.5 percent aloe vera cream cured 86 percent of the subjects. Each person used the aloe vera cream three times each day for a period of one year, and the researchers concluded that aloe vera cream is a safe and effective cure for psoriasis.
Try other topical creams. Many topical creams, oils, and ointments help psoriasis. Capsaicin, a cayenne pepper cream, helped 66 to 70 percent of the people who used it in a recent trial. The main side effect was that of a burning feeling associated with chili peppers, which quickly subsided. Vitamins A and E have also been used topically with success; one physician alternates them, one each day. Creams containing zinc are also effective, as are salves containing sarsaparilla. Goldenseal ointment or oral supplements can also be helpful.
Practice stress-management skills. Flare-ups of psoriasis often occur after a stressful event. Because stress has to do with our own internalization of an event, even a mildly stressful situation can trigger psoriasis. Learning stress-modification techniques can change your attitude about stressful situations, allowing you to let them roll by more easily. In a recent study, 4 out of 11 people showed significant improvement in psoriatic symptoms with meditation and guided imagery. Hypnotherapy, biofeedback, and walks in nature are other effective tools. Regular aerobic exercise is a powerful stress reducer.