Are you a foodie? Like many of you out there, I love trying new restaurants or the latest food craze but can sometimes overindulge. Nobody wants to admit it, but we truly are what we eat. Our nutrition is closely tied with the immune system and the immune system plays a pivotal role in our health. That’s why our weight and diet have an intimate relationship with certain conditions like psoriasis where inflammation is at the heart of the problem.
You might wonder, where does inflammation come from? Well, when you eat a high glycemic food, like a donut or a bowl of pasta, it causes your blood sugar to surge and insulin production to kick in. Insulin creates fat storage and if you store more fat around your belly, it’s called central obesity. Fat around your middle also concentrates around your organs and this is known as visceral fat. You might think of this fat as inactive or just hanging out, but it’s metabolically active. Visceral fat produces chemicals called cytokines that cause inflammation, and inflammation is what fuels psoriasis. This is why maintaining a healthy weight and reducing central fat is important as a part of psoriasis management.
Inflammation can also come from how our diet affects our microbiome. Studies have shown that psoriasis patients have an abnormal gut microbiome. The gut microbiome consists of organisms like bacteria, viruses, yeast, fungi and protozoa. The microbiome needs to maintain a sense of balance for optimal health. If you eat processed foods or simple carbohydrates, yes, like that donut, it can throw your microbiome off and contribute to inflammation. Our microbiome needs good nutrition too—yes, feed your gut! That’s what we call prebiotics, like non-digestible fibers that are found in foods such as onions, garlic, beets, broccoli, fruits and whole grains. Taking probiotics, the healthy bacteria in the gut, have also been shown to help psoriasis as well. In addition to processed foods causing inflammation so can omega-6 fatty acids (FA). Our Western diet consists of higher omega-6 FA compared to omega-3 FA. Omega-6 FA are found in refined or seed oils while omega-3 FA are found in salmon, flaxseeds and walnuts. By reducing the omega-6 in your diet and increasing the omega-3, you can reduce inflammation and help your psoriasis.
As for the weight connection with psoriasis—we know that the bigger a person is or if they are overweight/obese, the risk for having more severe psoriasis is higher. If someone is obese, often their psoriasis is more difficult to treat. Being obese can also increase the risk for developing psoriatic arthritis. Studies have shown that weight reduction can improve psoriasis and may reduce the risk of developing psoriatic arthritis. The link between obesity and psoriasis makes diet and nutrition a part of effective treatment.
What advice do I recommend to patients? Don’t follow the fad diets. The best evidence that we have right now is that the Mediterranean diet can be helpful to reduce inflammation and psoriasis symptoms. If you have symptoms of Celiac disease, then get tested. For those with gluten antibodies, following a gluten-free diet can improve their psoriasis. Minimize processed foods, alcohol intake, exercise regularly, consider taking a probiotic and increase your omega-3s. And while diet and nutrition are important for psoriasis, remember they are often a part of a comprehensive plan that also includes medical therapy.
Trotter’s Take: If you have psoriasis, following a Mediterranean diet that is high in omega-3 fatty acids and cutting back on processed foods is the way to go and reduces systemic inflammation.
Hungry for more? Be sure to check out my podcast with Dr. Steve Feldman as we talk more about psoriasis and the treatment landscape.
