Psoriasis and diet.  Are you what you eat???

Is there a link between psoriasis and diet?

Like me, I’m sure you’ve asked your dermatologist this question only to be told there’s no evidence.  But as a scientist I know just because there’s no proof, it doesn’t mean there’s isn’t a link. And as a long time psoriasis sufferer it seems more than logical that what I eat affects my health and skin.

The important thing to keep in mind is that these are difficult studies to design and run.  At the very least you’d need 2 groups of similarly matched people, with the same sort of psoriasis and treatments.  The first could carry on eating as they always do and then the ‘experimental’ group would have to follow your diet for a number of weeks – without deviating from your diet plan.  Anyone who knows anything about the diet industry will tell you that most people have trouble sticking to a prescribed diet.  So your experimental group would not only have to be large in number but also motivated, willing and able.  And of course you’d need someone to fund the study in a climate where big pharmaceutical drug trials are where the money’s at.

An example of one such study was carried out in Croatia (Rucevic et al, 2003).  The brave experimental group ate a low energy diet consisting of nothing but fresh and boiled vegetables, fruit, rice, bread and low fat dairy for 4 weeks while they were hospital inpatients.  The authors report significant changes in serum lipids but didn’t report on the differences in skin between the 2 groups.  We don’t know how many of the original 42 people made it to the end of the trial and how many popped out for a sneaky burger on the weekend and kept a bar of emergency chocolate in their hospital locker.

In 2018, the Medical Board of the National Psoriasis Foundation looked at the results of 55 studies.  The strongest evidence was for the benefits of weight loss for psoriasis in overweight people but they concluded overall the evidence is just not strong enough to draw any firm links between diet and psoriasis.

There’s lots of anecdotal evidence, much of it emerging from times of war and famine.  It has been alleged that in post World War I Germany, psoriasis all but disappeared from the population.  The same was reported in Dutch prisoners of war in WWII concentration camps.

This fits with reported findings from 70s Russia.  The Medical Institute of Dermatology in Moscow reported on their fasting treatment where people with psoriasis ate and drank nothing except mineral water and vitamins for 2 weeks and had daily enemas.  Not surprisingly their subjects lost lots of weight and there was some improvement in skin which reversed as soon as they started eating normally again.  It would seem that a low energy diet reduces the severity of psoriasis. But just to throw a spanner in the works, there are also reports of an increase in the incidence and severity of psoriasis during WWII (Lombolt, 1963).

The incidence of psoriasis is reportedly low in Eskimo and Danish populations which have drawn some researchers to link this with their high intake of fish oils and fatty acids.

So while there are a fair number of studies and lots of anecdotal evidence we are still left in the dark. As for me, from my early teens to the present day I’ve been following different diets in an attempt to control my psoriasis symptoms.  I’ve tried dairy free, gluten free, vegan, vegetarian, Pagano, sugar free and the list goes on.  I have often wondered whether the pursuit of a ‘psoriasis clearing diet’ means I’m restricting what I eat unnecessarily.  I also have concerns about whether these diets can cause a form of eating disorder or orthorexia – but that’s for another post.

I’ve been following a whole food plant based diet for the past year and I’m feeling great about it.  I still have psoriasis but it’s nowhere near as bad as it normally is this time of year.  With over 30 years of my own trial and error, I have a fair idea of the food which makes my skin flare up and what I need to stay away from to help it calm down.  But I could be wrong……..

References

Makeev V. D. (1976) Vest. Derm. Vener., 4 58.

Rucevik I. et al (2003) The Role of the Low Energy Diet in Psoriasis Vulgaris Treatment Coll. Antropol. 27 Suppl. 1, 41–48.(https://pdfs.semanticscholar.org/f125/7dd04c70370c563cd658387ec24db2b4d76c.pdf)

Lombolt G. (1963) Psoriasis, 26, 123.

Herschel S et al (1969) Arch.Dermatol., 99, 580.

Searching For A Cure For Psoriasis

I’ve been thinking about how the search for a cure affects our well being. In my twenties I found an ‘alternative’ treatment called Skin Cap. The online community was reporting great success and it contained nothing more harmful than zinc. I bought a few cans and was delighted. It was a spray, easy to use and cleared my skin in record time. I bought several more cans and sprayed away with joy. However it did all seem too good to be true. I was noticing side effects like thinning of my skin and bruising so I wasn’t surprised when it emerged that it contained an unlisted steroid. I stopped using it and had the worse rebound ever. But even worse than the flare in my symptoms was the horrible feeling of being let down and having my hopes dashed. Not surprisingly I became quite low and depressed. I thought I had found the answer to my psoriasis and had been ‘in control’ for the best part of a year. I felt cheated and let down and determined not to fall for a ‘miracle cure’ again.

I have had psoriasis for over twenty years and in that time have tried many ‘cures’. The disappointment I have felt when they fail always affects me deeply and more so than the waste of the money or time. In more recent years I have come to the decision that I won’t invest any hope, time or effort in a ‘miracle cure’ that costs money. I am prepared to try treatments that involve healthy lifestyles like cutting out wheat and processed food and taking vitamins, as I believe that it will probably do me some good even if it doesn’t clear the psoriasis. This is my personal decision but is it the best approach to take? What does the research suggest I should be doing? Should I accept my psoriasis or should I keep trying new potions and searching for a cure?

With this in mind I searched healthcare databases (Medline and PsychInfo) for research looking at acceptance and coping. I found one relevant paper by Zalewska et al (2007) that suggested factors such as higher levels of optimism and a lower conviction of others’ influence on one’s health were linked with acceptance. The authors also stated that a lack of acceptance is associated with poorer medical adherence and delayed clinical improvement. In other words, if I accept my skin as it is, I am more likely to follow doctor’s orders and get better, and I am more likely to accept it if I feel optimistic and don’t think that my health is dependent on someone else.

Whilst not specifically answering my question, this research would suggest that I should be optimistic that something will work (keep trying) and I should have belief in my own ability to cure it (don’t rely on someone else to find the cure for me). Whether or not I should invest any hope or money in a cure remains unanswered. If you know of any research that addresses this question I would be very interested to hear more.

References

Zalewska A,Miniszewska J,Chodkiewicz J,Narbutt J (2007). Acceptance of chronic illness in psoriasis. Journal of the European Academy of Dermatology & Venereology, vol./is. 21/2(235-42), 0926-9959