Psoriasis is one of those conditions that if you suffer from it, it is something that you're told you have to live with. But that’s not necessarily the case.
Psoriasis like many skin conditions is multi factorial meaning that there’s no one known cause which often makes it harder to treat. This does mean that more often than not, then steroids, lotions and creams are prescribed to treat the symptoms of psoriasis.
But is that all there is to it or can more be done to reduce symptoms and make living with psoriasis a little less uncomfortable for those that have the condition.
So, what do we know about psoriasis?
Psoriasis is a chronic inflammatory skin disease, which means that it causes the immune system to mistakenly attack healthy cells. It causes symptoms on the skin and sometimes the joints, and this often appears as scaly and itchy patches on the skin which can often become inflamed. It can occur anywhere on the body including the scalp, hands, feet and genitals.
There are several types of psoriasis with different manifestations. The most common is plaque psoriasis which often appears as plaques from the build up of skin cells that are red, itchy and sore, with white or silvery scales.
Scalp psoriasis is found on the scalp but also the hairline, neck, and behind the ears. It causes dandruff like flakes to fall out as well as thinning of the hair.
Guttate Psoriasis also known as teardrop psoriasis appears as a rash of small red spots that are widespread particularly on the torso, back and arms and legs. This type of psoriasis often occurs in young children, teenagers and young adults.
Pustular psoriasis refers to both Palmoplantar Pustulosis (PPP) as well as Generalised pustulosis psoriasis (GPP).
People with PPP often have very red or dark skin on the palms of the hands or soles of the feet, covered with small pustules which are filled with a clear or creamy fluid.
So what causes Psoriasis?
Now this part is unknown, in fact its multifactorial meaning that there are often several reasons that psoriasis appears.
If you type in Google causes of psoriasis there will be lots of different theories and ideas. What we do know is that Genetics plays a big part in the development of psoriasis, as does our immune system, Stress, our gut health as well as food triggers.
One thing is for sure, is that treating the symptom often isn’t the best solution and that we should be looking at the route cause and supporting our body to reduce symptoms rather than just cover them up with steroids and lotions that often just strip away the inflamed skin which then comes back when new skin cells regenerate.
If genetics plays a big part in it, does that mean you are predisposed to the condition and there’s nothing you can do? That’s definitely not the case. Okay so one of your parents had it, but that’s not to say that you will inherit this condition, in fact we have the power to turn on and turn off certain genes that predispose us to illnesses and diseases.
This is particularly relevant with autoimmune conditions which often predispose us to them. But autoimmune diseases arise from not only our genes but also environmental triggers. You see a combination of these two things disrupts our bodies own immune system’s ability to ignore a person’s own tissue and cells, therefore resulting in the symptoms of psoriasis.
So, we have the ability to almost turn off these genes that predispose us to certain conditions and our environment, lifestyle, diet and stress levels all play a part in this.
What we know is that psoriasis is inflammation but that’s not necessarily on the skin, in fact most inflammation begins within the body and we know that psoriasis is a combination of increase in inflammatory markers such as IL-23, IL-17 pathway, reactive oxygen species, suppression of T cells which results in inflammation, and gut dysbiosis.
Yes the gut plays a pivotal role in symptoms of psoriasis. With 70% of our immune system produced in the gut, then any imbalances within the gut can result in dysregulation of the immune and inflammatory pathways and auto-immune conditions.
Very often unbalanced dietary habits play a role in the manifestation of psoriasis and gut dysbiosis, with Higher intake of trans fats, lower intake of fish and dietary fibre, combined with high intake of simple sugars, red meat and alcohol. These factors cause a cascade within the bodies inflammatory pathway causing inflammation and gut dysbiosis.
Studies have shown that people with psoriasis have less diversity in the gut microbiota than healthy individuals.
So if we know that Psoriasis is an inflammatory condition, what we need to be looking at is reducing the inflammation and that includes what we eat, our lifestyle as stress can be a big trigger for inflammation and our lifestyle.
Omega 3 from oily fish has a big influence on not only our gut health but also reducing inflammation. The EPA and DHA found in fish such as salmon, sardines and mackerel are anti-inflammatory, and they help to reduce production of pro-inflammatory cytokines within the body. Omega 3 fats also exert a positive action by reverting the microbiota composition in these diseases and increase the production of anti-inflammatory compounds.
Deficiency in vitamin D has been associated with increased autoimmunity as well as an increased susceptibility to infection. Vitamin D has many roles within the body from supporting bone health to immune function by modulating the innate and adaptive immune responses. and with this in mind, numerous studies have shown that vitamin D plays a role in reducing auto-immunity susceptibility and even reduce inflammation associated with these conditions.
Probiotics are live bacteria that can have a positive influence on our own gut microbiota. Stress, high consumption of sugar, low dietary fibre in our diet, alcohol consumption, medicine use, antibiotic use can all influence our own gut flora causing imbalances and inflammation that isn’t just localised in the gut but can manifest in others areas such as the skin, and joints. Probiotics provide our gut with beneficial bacteria that helps to restore and balance out the good bacteria from the not so good bacteria which can result in inflammatory issues.
Fibre rich foods such as prebiotics, colourful vegetables, fruit, wholegrains help to feed that good bacterium and provide wonderful nourishing nutrients that reduce inflammation and support gut, skin and immune health.
Although there isn’t any one fix, there is lots that can be done to establish a cause, reduce inflammation and improve symptoms without the need to use steroids and lotions. Remember that we are all different and there isn’t a one size fits all approach to any condition but that’s where Nutritional Therapy plays a part in establishing what works for you, looking further than just the symptom and working to address any imbalances and helping to find comfort.
If you would like to find out more about how nutritional therapy can help you or to book an appointment click here.
Calder P. Omega-3 fatty acids and inflammatory processes: from molecules to man. Biochemical Society Transactions. 2017;45(5):1105-1115.
Costantini L, Molinari R, Farinon B, Merendino N. Impact of Omega-3 Fatty Acids on the Gut Microbiota. International Journal of Molecular Sciences. 2017;18(12):2645.
Changes in stool frequency and consistency can have a lockdown effect on our overall health, driven by and driving and perpetuating digestive disorders in a self-feeding cycle, where poor digestive capabilities increase stress and inflammation, and inflammation and stress suppress digestive processes.
If you are taking drugs that suppress stomach acid production (e.g., omeprazole and PPIs), it is very likely that your digestion is not optimal and the cause of bloating, flatulence and constipation. It may be important to address the causes of heartburn and GERD to re-establish normal stomach function and reduce the sensation of burning due to low-stomach acid (NOT excessive stomach acid production).
Increase your water intake. Again, dehydration is one of the main culprits in chronic constipation. Keeping a bottle of water by your side at all time can be a great reminder to drink more. Setting regular alarms in the day, can also remind you to drink. Drink plenty of water or herbal teas in the day to stay hydrated.
Ensure you consume your five-a-day, and aim to increase to ten portions of vegetables a day and a couple of fruits (no more than three). A handful of berries or a cup of vegetables qualifies as a portion. For indication, one apple makes one of your five-a-day. Two apples still make one of your 5-a-day. So a varied, balance diet with as many different colours of vegetables is highly recommended.
Increase dietary fibre intake. However, it is important to consider that insoluble fibre feeds for the ‘good’ and the ‘bad’ bacteria. Yet, the good kind has a greater affinity with soluble fibre. Starting low and slow is of the utmost importance to prevent symptoms to worsen. Studies have shown that increasing fibre intake to around 29 grams per day is optimal. Intake of over 38 grams doesn’t display any benefits and may lead to diarrhoea. If your diet mainly revolves around ready-made meals, take-aways and ultra-processed manufactured food products, start by incorporating fresh fruits and vegetables in your diet. Then, aim for 50% of your plate being vegetables. Mix a variety of raw (salads, fermented foods like kimchi) and cooked (soups and broths, steamed or baked) vegetables. Antioxidant-rich they also play a key role in balancing inflammatory responses and reducing free radical damage; therefore, always aim to consume one vegetable of each colour (Orange: sweet potatoes, squash, oranges, papaya. Blue: blueberries, blackberries, blue carrots and tomatoes. Red: tomatoes, red peppers, radishes and beetroots. Green: especially vegetables from the brassicae family like broccoli, Brussels sprout, cauliflower, kale and cabbages, spring/collard greens. Yellow: yellow peppers, beans and courgettes, pineapple, mango, and pumpkin).
If you are choosing to supplement with prebiotic fibre (GOS, FOS and XOS), again start low and slow, and build up to optimum dosage. The severity of symptoms appears to be dose-dependant. However, symptoms associated with increased dietary fibre intake may dissipate within a two-week period and so, daily intake is highly recommended to offer any benefit and allow for beneficial bacteria to change the gut milieu to a more acidic environment (lactobacilli and bifidobacteria produce lactic acid), which is essential to displace and keep oxygen-breathing pathogenic microbes under control.
Consider the following foods, which are high in insoluble fibre:
• Flax/linseeds, sunflower and chia seeds
• Almonds, hazelnuts and walnuts
• Oat/wheat bran and germ
• Beans, lentils and legumes
• Dry fruits (sulphite-free)
• Apple and pears (also contain sorbitol a type of sugar that many people cannot digest, leading to bloating and gut discomfort).
• Greens (spinach, lettuce, kale, mesclun, collards, arugula, watercress, etc.)
• Peas, snow peas, snap peas
• Green beans (also an excellent source of silica)
• Bell peppers
• Onions, shallots, leeks, scallions, garlic
• Brassicae: broccoli, Brussels sprouts, cabbage, cauliflower, kale, pak choi
If you suffer from any gut disorder, start with the following vegetables that are high in soluble fibre, but lower in insoluble fibre (these tend to be safer for those with gut issues):
• Carrots, sweet potatoes and squashes (peeled)
• Asparagus tips
• Starchy tubers (yams, sweet potatoes, potatoes)
• Turnips and greens
• Rutabagas (Swedish turnips)
Keep away from food to which you may be hypersensitive or those that are known to promote inflammation (e.g., gluten, dairy products) until you have resolved gut issues and constipation.
Lastly, any food that have an effect on liver function and the production and flow of bile are also highly recommended. Remember that bile acts as a mild laxative and is also essential for absorption of nutrients and elimination. Choleretics (substances that increase the volume of secretion of bile from the liver) and cholagogues (stimulate gallbladder contraction to promote bile flow) should, therefore, incorporated in the diet daily. Consider the following in cooking and in herbal preparations like teas or tinctures (always consult your health practitioner before supplementing with extracts):
• Chamomile (Chamomilla recutita)
• Elecampain (Inula helenium)
• Dandelion (Taraxacum officinalis)
• Artichokes, including Jerusalem artichokes
• St. John’s wort (Hypericum perforatum)
• Artemisia sp
• Yarrow (Achillea millefolium)
• Rosemary (Rosmarinus officinalis)
• Chelidonium majus (from the poppy family)
• Any bitter foods (e.g., wild rocket leaves, watercress, Swedish bitters)
If you suffer from gut disorders, soothing the digestive tract may be fundamental to recovery and reduce constipation. A demulcent is a herb rich in mucilage and can soothe and protect irritated or inflamed internal tissue. Include those (always consult your health practitioner before supplementing with extracts):
• Marshmallow leaf or root (Althea officinalis)
• Slippery Elm (Ulmus fulvus)
• Liquorice (Glycyrrhiza glabra)
• Flax/linseeds and chia seeds also provide soothing mucilage (mucous-like substance)
Other herbs to consider include mint, ginger, turmeric and fennel seeds to further reduce inflammation, improve digestion, reduce gas and bloating.
It may also be recommended to reduce caffeine and alcohol consumption to allow for the gut to heal and restore peristalsis. Avoid sugar as much as possible. Remember to eat until satiated (just before you feel full), so that you supply enough roughage to increase bulk.
Reduce the load on the digestive tract by consuming pre-digested foods. For example, fermented foods like kimchi and sauerkraut, as well as broth, stews and slow-cooked preparations. You may also benefit from supplementing with digestive enzymes if you are under stress, anxious or taking certain drugs that can impede with digestion.
Practice mindful eating. Mark a pause before touching your food, to break your state from hyperactivity to a more relaxed state, which is essential for digestive function. Chew each mouthful and take you time to eat.
Do not mix too many food groups in one sitting and do not drink more than one glass of water with your meal.
Exercise is key for movement. A sedentary lifestyle is associated with a sluggish immune system and stagnation (retention of waste) and constipation. Aim to take part in any physical activity every day — adapt your regime to your abilities. Haven’t exercised in a a while? Consider stretching and yoga to get you on the way to a more healthy lifestyle and healthier mind.
Consider gentle enemas to improve regularity.
Magnesium deficiency has also been linked to constipation and is also involved in the stress response and relaxation. Supplement with magnesium if necessary.
Source: The Gale Encyclopedia of Medicine. (2015). 5th ed. Blackbirch Press.
Sharma, A. Rao, S. (2017). Constipation: Pathophysiology and current therapeutic approaches. Handbook of Experimental Pharmacology. 239: pp. 59–74. 18
A quick insight into the digestive system
Digestion involves the mechanical and chemical breakdown of food into smaller components that can be more easily absorbed and assimilated by the body. A host of digestive organs work in harmony (including the digestive tract, pancreas, liver, and gallbladder) to ensure that we are able to extract the nutrients from food to power the demands of the body. Once food has been efficiently digested, it needs to be absorbed into systemic circulation.
The upper part of the digestive tract, consisting of the mouth, oesophagus, stomach and the initial part of the intestines (the upper duodenum), is where most chemical digestion takes place. Digestion begins in the mouth, with the mechanical action of chewing, enzymes contained inside saliva (amylase enzymes initiate the breakdown of starches). The stomach, via the release of acid release, continues the digestive process by allowing the breakdown of proteins and fats (due to the effect of pepsin and gastric lipase respectively), and mineral dissociation (stomach acid is required to assimilate minerals). The release of the intrinsic factor by stomach cells is essential to chaperone B12 and allow for its absorption by the colon. Highly corrosive stomach acid also sterilises the milieu, the first barrier against pathogenic microbes ingested with food.
The pancreas secretes alkalising compounds to increase the pH of chyme (a mixture of partially-digested food and stomach juices), as well as digestive enzymes that allows for the continuous breakdown of food. The brush border, the upper part of the intestinal tract, also secretes digestive enzymes.
At the same time, the liver produces bile, which is collected and distributed in great amount by the gallbladder, allowing for the emulsion of fats (breakdown of fat into fatty acids) and the absorption of fat soluble compounds (e.g., fat soluble vitamins). Bile also displays mild laxative capabilities.
Nutrients are now ready to be absorbed. Most nutrient absorption occurs in the jejunum, the central area of the small intestine. The formation of cellular villi and microvilli increases the surface of absorption and the motility of food through the small intestinal tract.
By the time food remains enter the colon, it is ready for elimination. However, the colon is also the part of the digestive tract where useful material is reabsorbed. This includes water (the large intestine plays a crucial role in maintaining positive water balance), electrolytes and certain vitamins. While the colon doesn’t produce digestive enzymes, the digestive process is continued, being taken over by the resident microflora. Gut bacteria release short-chain fatty acids and a multitude of other health-supporting metabolites feeding on dietary fibre and other nutrients (e.g., sugar and undigested food components).
The timely movement of food and fluid through the digestive tract is essential to digestion, absorption and elimination. Disrupted peristalsis and the consequent slowing down or speeding up of this process has been associated with many conditions including gastroesophageal reflux disease (GERD) , SIBO/SIFO, constipation and/or diarrhoea, and complications related to malabsorption and impaired detoxification.
These processes can be disrupted by many factors, including stress (anxiety, depression, overwhelming life demands and poor coping mechanisms), eating too fast, eating too much and mixing too many food groups in one sitting, drinking too much liquid with a meal, eating on the go or eating while working. Again, relying on poorly-nutritious ultra-processed food products may irritate the lining of the digestive tract, fuel inflammatory responses and disrupt enzymatic and absorptive capabilities. A lack of dietary intake will also play is part in poor motility and waste retention.
Low stomach acid can have a knock-down effect on all processes occurring at any stage of digestion. As explained earlier, stomach juices are essential to break down proteins and fats and the assimilation of minerals and vitamin B12. Low stomach acids due to suppressed digestive capabilities under the action of stress (or chronic inflammation, or certain drugs) can lead to proteins putrefying inside the digestive tract and produce gas, leading to bloating and abdominal discomfort and, in severe cases, debilitating pain. The absorption of nutrients and amino acids (the building blocks of life) can be greatly compromised as a result, even more so if sugar is present. Sugar fuels inflammatory processes and also plays a key role in dysbiosis, immune dysregulation and increased intestinal permeability.
Constipation is one of the most common medical complaints in the western parts of the world. A significant portion of the population describe being constipated continuously or frequently.
nternationally, the incidence of constipation varies, depending largely on dietary habits. Constipation can occur at any age, and is more common among individuals who resist the urge to move their bowels at their body’s signal especially in the morning. Also, this often happens when children start school or enter daycare and feel shy about asking permission to use the bathroom or are prevented to do so. It also can happen to adults who are in jobs where they cannot take bathroom breaks at will. Constipation is more common in women than in men and is especially likely to occur during pregnancy. Dietary changes linked to ageing may also be involved. People over age 65 and particularly women are more likely to experience constipation.
Constipation is an acute or chronic condition in which bowel movements occur less often than usual or consist of hard, dry stools that are painful or difficult to pass. It is characterised by infrequent bowel movements (less than 3 times per week), stools that are difficult to pass or have a hard consistency, and a sense of incomplete evacuation, as well as abdominal bloating.
When waste sits or moves very slowly throughout our digestive tract, it gets fermented by microbes and becomes a literal breeding ground for all kinds of opportunistic and often pathogenic microbial species. These species than produce all kinds of toxins that create a stress response in our body and increase whole body inflammation levels. Therefore, constipation is a very serious condition, especially if chronic.
Clinical observations display a very concerning picture with many people only going to the toilet once a week or even less often. This problem can significantly impact the quality of life for all ages, and evidence shows that it is affecting 20% of the population.
Some people may be dealing with bouts of constipation and diarrhoea, where compacted stools may prevent colonic emptying — only watery stools can escape.
As the colon is involved in water balance, dehydration will have a more or less severe impact on the hardness of stools, and so constipation. Again, a diet low in dietary fibre may not provide sufficient bulk for regular stool formation. Food hypersensitivities to gluten, dairy and other specific foods can increase the likelihood of chronic constipation.
Gut function, introduction
The gut is an adaptive interface, an important part of the digestive system which separates the outside world from our internal world: a tube with two endings. The mouth at one end and the anus at the other. The inside of the tube may, in fact, be considered external to the body, because the influence of the outside environment can be felt inside this tube.
If we look at the gut in a simplistic way, it acts as border control, only allowing “passport-holders” to enter. One individual (or nutrient) can pass this border at a time, in the same way we cross border control at an airport. This means that large groups of people (large molecules) must be broken, and this is what the upper part of the digestive tract is entrusted with: get each individual (nutrient) ready for border control (absorption).
It has been known for millennia that “all disease begins in the gut” a common phrase attributed to Hippocrates (460–377 BC), but we are only beginning to truly understand the pivotal role of the gut in health and disease. Imagine if large groups were able to push through border control and cross the frontier, and carry their luggage with them (as observed in increased intestinal permeability, or leaky gut syndrome). Imagine individuals carrying weapons and attacking border control staff (reactive molecules like gluten and those found in dairy products, as well as toxic substances like some additives, traces of solvents manufactured from petrochemicals, and pesticides). Imagine a loud, problem-making group of individuals (sugar), disturbing the entire environment and driving chaos. Imagine this happening all day every day. Border control would become a place at war, desperately trying to hold their position while being attacked on every front, with commonly innocent individuals (lectins, phytic acid, histamine) and residents (opportunistic pathogens) throwing all they got (microbial inflammatory by-products) at border control in order to maintain chaos, which can only get worse if the perpetuators are not removed. Once eliminated, the inflammatory situation may still remain for a while, but, eventually, the area will return to normal and order may be restored. It is not to say that future outbreaks are impossible, especially that those ‘seemingly-innocents’ have experienced the full extent of their power.
Back to our physiology.
The gut is designed to process food in order to provide the energy, building blocks and cofactors essential in every biological process. It is also a two-way interface that allows for the elimination of metabolic waste and other substances. It is also a barrier against ingested pathogens and other factors. The gut, therefore, play crucial roles in digestion and absorption, integrity and immunity, motility, and balancing the gut microbiota. Any issues arising from any one of these key roles will have an impact on the assimilation of essential nutrients and on our overall health and well-being.
The impact of our modern world on our gut environment
It is not surprising that our gut and its integrity is being put to the test since the industrial revolution. Since then, new processing methods and new molecules have been invented to increase standardisation and profitability by using cheap ingredients and the manufacture of convenience and ultra-processed food products. A dramatic shift happened in human history at this time. We became disconnected from our roots, from nature, with the masses moving to the cities, and from food. Eating became associated with pleasure and no longer seen as a necessity to fulfil our most basic physiological requirements. Meal settings and habits were also broken. We started to eat much faster, often eating on the go or at our desk, and more often, a shift also triggered by the addictive ingredients newly-incorporated in the food chain.
Today, less than 50% of people eat fresh foods and far too few consume 5 of their 5-a-day. In fact, NHS UK displays alarming statistics: In 2018, only 28% of adults and 18% of children aged 5 to 15 were eating the recommended five portions of fruit and vegetables per day.
Eating less nutritious foods, like fruits and vegetables, and eating a greater amount of ultra-processed manufactured food products known to contain a multitude of additives and addictive substances, is raising serious safety concerns. In fact, many additives have been shown to impact the constitution of the gut microbiome and play a part in disease involving microbial imbalances, inflammation and stress.
Eating faster, mixing too many food groups in one sitting and the increased complexity of food poses a bigger challenge for our digestive system and it is likely that we have not yet adapted to those changes. This may correlate with the explosion of metabolic disorders and increased rate of obesity and diabetes.
At the same time, malnutrition is back in the Western parts of the world where food abundance is highly common. Therefore, malnutrition is no longer linked to not having access to food but to particular dietary choices, including poorly-nutritious diets revolving around ultra-processed manufactured food products, or other types of restrictive diets (crash dieting, calorie-controlled diet, strict diets like paleo, ketogenic or vegan diets, or supervised or unsupervised therapeutic diets, like the FODMAP diet).
While our diet is having a major impact on our health, one of the key components of health that is the subject of much dispute, is fibre. Many studies have demonstrated that excess intake of fibre does not protect the body from metabolic disorders and may actually be harmful, particularly for gut health. When it comes to research, the invested parties, the choice of the studied substance, and conflicts of interest must be accounted for, and this is why there are so much contradictory conclusions. , It may be anticipated that using highly-reactive molecules in studies, like gluten found in wheat cereal products, may cause inflammatory responses that negate the health-supportive effect of dietary fibre.
Fibre: Insoluble or soluble?
Fibre is essential to create bulk and maintain peristalsis, the one-way movement of the digestive tract, generated by stress impacted to the cell wall by food or stools. In response to the pressure, cells of the digestive tract wall contract, pushing the matters forwards, in a — domino-like effect — series of wave-like muscle contractions, until most or all nutrients from food and water have been extracted, and the stools reach the rectum, ready for elimination.
Insoluble fibre, on the other hand, do not participate to the formation of stools. This type of dietary fibre is often referred to as prebiotic fibre and, therefore, play a pivotal role in the balance of the gut microflora. This type of fibre is essential to life. We are clearly outnumbered. We harbour a multitude of microbial communities which shadow our own cells, and so, the impact of the gut microbiome on our body, in health or disease, cannot be any more apparent. Feeding the gut microflora with the right kind of raw ingredient is, therefore, crucial to maintain a healthy gut milieu that is contributing to our health and overall well-being. It is now understood that the gut microbiome has an effect on our mood and our emotional balance, as well as our cognition. Poor cognition and neurodegeneration has been linked to 11 dysbiosis (a disturbed gut milieu), increased intestinal permeability and a sugar-rich diet, among other 12 key dietary components, like a very low (soluble) dietary fibre intake.
If you've been struggling with your digestive health and would be interested in looking into things further why not book in with one of the team? You can find full details of what's involved here.
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