Psoriasis and psoriatic arthritis: the origin lies in the gut.

So, what’s psoriasis?

Psoriasis is a chronic autoimmune condition which produces an overgrowth of skin cells. This in turn causes inflammation which shows in the form of red skin, pain, heat, flaking and edema. The origin of this disease still remains unknown, though it has been speculated that there is a malfunction of T cells in psoriasis sufferers. There seems to be a clear genetic factor, which, however requires an environmental trigger in order for the condition to develop.

It’s a fairly common pathology, affecting roughly three percent of population. Most of the cases are mild, covering about three percent of the body surface. In more than half of sufferers symptoms first appear between the ages of 15 and 35.

Note the typical scaly skin

Is psoriasis the same as dermatitis or eczema?

No. Though they’re all chronic conditions with similar symptoms, dermatitis causes dryness and itchy skin which worsen with scratching, while psoriasis causes swollen patches of skin due to the accumulation of cells.

What causes the disease?

It is known that T cells, which normally protect our bodies from infections, alter their activity and attack epithelial cells. However, the origin of this mechanism isn’t yet well understood. Several options are being considered, and are quite likely complementary:

  • Genetic factors: mutations of CARD14 gene predispose towards psoriasis. If you have a family member who suffers it you are 30% more likely to have it too. If both parents suffer from it, there’s a 50% change the child will also do so.
  • Environmental factors: overweight, infections, smoking, alcoholism, stress and some medicines.

The theory on the origin of psoriasis:

What is most widely accepted up to this day is that for predisposed individuals (those who have certain genes), the appearance of a key environmental factor or a mixture of several ones (antibiotic consumption combined with poor diet, acute stress or an infection, for instance) can alter the immune system’s function, producing T cell activity against our skin cells. This would partially explain why about 60% of psoriasis sufferers admit to have taken excessive amount of antibiotics prior to the appearance of symptoms. It is also common to find a link between symptom appearance and a particular event such as a highly stressful period or an acute infection. Both would have a similar effect.

Then, why do we say psoriasis starts in the intestine? Well, because the origin of the alteration of T cells lays in the gut, more specifically in the intestinal biota, which regulates the immune system through TREGS (regulatory T cells). If a certain strain of our biota is eliminated (say by taking antibiotics) the whole functioning of the immune system may change. Almost all psoriasis sufferers show an increased intestinal permeability compared to healthy individuals. It is also known that unbalanced gut flora can cause the appearance of psoriasis-type lesions. Considering this situation, it seems obvious that treatment of the epithelial symptoms should concentrate on the true origin of the condition: the gut.

The back is frequently affected.

Types of psoriasis:

There are five clearly different types of psoriasis:

  • Plaque psoriasis: it’s the most common type (roughly 80% of patients). Lesions are first red and swollen and then become scaly.
  • Inverse psoriasis: lesions occur in areas prone to rubbing such as the folds of the skin (armpits, under the buttocks, etc.)
  • Erythrodermic psoriasis: if affects large surfaces of the skin, with big edemas and a lot of exfoliation. It normally indicates a severe situation.
  • Guttate psoriasis: more frequent in children, small pink bumps appear on different body parts.
  • Pustular psoriasis: quite uncommon, this type of psoriasis is characterized by the appearance of pustules filled with pus surrounded by reddened areas.

Conventional treatment for psoriasis:

For milder cases, the typical treatment consists of special shampoos or cortisone creams. For more severe cases synthetic treatments such as biological drugs are  commonly used.

  • External medication: shampoos, cortisone creams, etc.
  • Phototherapy or light therapy: UVB rays (either naturally obtained through sun or via artificial exposure) slows the production of epithelial cells. UVA rays should be avoided since they are linked to the appearance of neoplasms and skin cancer.
  • Systemic medication: the well-known biological drugs suppress specific inflammation routes in our body. Thought approximately 25% of patients are in remission and another 25% obtain some benefits from them, there is no data related to their long term safety. Also, half a dozen biological treatments have been taken off the market in the past 10 years due to proved toxicity. Taking into account this risk-benefit profile, we only support this therapy in very severe cases.

Effectiveness of psoriasis treatments and increasing toxicity.

Can psoriasis be prevented?

Unfortunately our genes can’t be modified. However, as it is mentioned earlier, this condition frequently appears when genetics is combined with some environmental or lifestyle factors. Therefore, our efforts should definitely be focused on the latter, reducing exposure as much as possible:

  • Reduce stress: avoid toxic personal relationships, do sport outdoors, enjoy the sun and learn some relaxation techniques (yoga, meditation, etc… it’s something very personal, so try some different ones out!)
  • Take care of your skin: don’t burn it and moisturize.
  • Avoid infections: keep away from sick people, wear enough clothing, avoid bad food, etc.
  • Take care your gut (and your family’s): avoid antibiotics and NSAIDs, shoot for giving birth naturally (avoiding c-section), breastfeed instead of using infant formulas.

Is psoriasis contagious?

Not at all. As we’ve mentioned earlier, it’s an autoimmune pathology. Though some people can develop it after a streptococcus infection you mustn’t fear contagion.

Where does it typically appear?

Though the scaly, reddish patches can appear in any part of the body, there are a few places where it is more common:

  • Back of the neck
  • Face
  • Feet, hands and nails
  • Genitals
  • Skin folds: buttocks, armpits, etc.
  • Back of the knees and elbows

How is it diagnosed?

It’s normally enough with a quick look by an expert dermatologist. In the most difficult cases, one can turn to a biopsy for diagnosis. Up to this day there aren’t any blood tests that allow to detect the disease, although some values (CRP, sed rate) can be altered, specially if you also suffer joint inflammation.

What’s psoriatic arthritis?

It’s a rheumatic disease similar to ankylosing spondylitis, which occurs in 20% of psoriasis sufferers. Treatment is more or less the same as in other arthritis, so biologics are the drugs of choice when psoriasis and arthritis coexist. Normally, taking the psoriasis into remission implies an improvement of the arthritis. This is due to the fact that they’re actually both a manifestation of the same disease: the origin of both lies in the gut. Treating arthritis frequently takes longer than psoriasis, so one should be both persistent and patient throughout the process. Psoriatic arthritis typically responds very positively to dietary changes: Dr Seignalet treated 39 patients, 25 of which improved at least 90%. By addressing the underlying issue, we’ll be improving both the arthritis and the psoriasis.

Natural approach to treating psoriasis and psoriatic arthritis:

In chronic diseases such as these, the patient should make a real effort in order to improve his or her quality of life, minimizing the intake of medical drugs. Just some lifestyle and diet changes as well as a few supplements are solidly supported by science as effective. Why should we reject something that has no secondary effects and that is likely to improve our quality of life? In the following lines we’ll list the natural treatments that in our opinion have enough scientific support to be recommended:

  • Diet: unfortunately there isn’t a specific diet to address psoriasis and psoriatic arthritis. Both common sense and numerous studies suggest that the cleaner the diet the fewer the symptoms. For example, Douglass treated 6 patients with an elimination diet and they all reached remission. Another fairly recent study showed that psoriasis patients more frequently suffer non-celiac gluten sensitivity, which worsens the symptoms. In obese patients, a cleaner diet together with an exercise program contributed to a visible improvement of symptoms. In these cases, weight loss is also vital, since it reduces stress from the joints. Another study linked psoriasis and gluten consumption. Omega-3 also seems to have an important role in this condition. Vitamin D and selenium seem to involve possible treatment paths. Therefore, a fish and seafood rich diet is definitely something to consider. Without a doubt, Jean Seignalet is probably who has had the broadest experience treating psoriasis. He treated 72 patients with his diet, 45 of which reached remission and 15 of which improved significantly. Results speak for themselves. We highly recommend reading his book, in which he explains all about his diet and other treatments for autoimmune diseases. His work is summarized in our article and you can get a hold of his book through this link. On the other hand, Sarah Ballantyne’s Autoimmune Protocol has become quite a hit lately. It’s basically an elimination diet which later reintroduces those foods that don’t produce symptoms. It might be, along with Seignalet’s, the best option for the treatment of psoriasis and the autoimmune conditions. You can buy Sarah’s book on Amazon here. So basically, the most suitable diet for psoriasis would include plenty of fresh veggies and fruit, good quality fish and seafood, eliminating sugars, processed foods and junk food. Contrarily to other autoimmune diseases, results in psoriasis are quickly visible in the skin (though pain wise they may take longer to show).
  • Omega 3: both these papers (1 and 2) show how supplementing with omega-3 is very beneficial for psoriasis treatment. Apart from supplementing with a product such as this one, do eat plenty of fatty fish such as mackerel, sardines, salmon or trout.
  • Vitamin D: a recent study review showed that orally taken vitamin D is just as effective as cortisone for the treatment of psoriasis. We recommend supplementing to reach serum levels of about 60 ng/ml. Do not forget to sunbathe so to enjoy the benefits of this hormone. We usually recommend high-quality products such as this one.
  • Aloe vera: both these two (1 and 2) studies proved that topic application of aloe vera extract was useful in the treatment of psoriasis. It is even being debated whether is might be more useful than cortisone cream. If you have an aloe plant at home you can cut a leaf and apply the gel to the affected area. If you don’t have a plant, try to find a pure aloe vera cream. We usually   recommend this cream which is providing excellent results even in cases that don’t respond to cortisone creams.
  • Tea tree oil: this oil has been used for centuries to treat and disinfect wounds and injuries. Since it’s such a strong product, we recommend using small quantities mixed with another helpful product such as coconut oil.
  • Cannabis oil: these three studies support the use of cannabis oil in psoriasis patients. It’s a totally legal product and is used widely in many countries. Watch out for supplements that don’t contain what they say they do. We particularly like this one as it contains the highest therapeutic dosage and we know quite a few patients that even reached drug-free remission with this product (see reviews here)
  • Curcumin: this might be the natural treatment with most research behind it. Curcumin is effective even in severe psoriasis and doesn’t have any adverse effects. In our opinion it’s a must. Do choose a high-quality product that is absorbed well in order to guarantee the benefits of this root extract. We recommend this one to our followers as the BCM-95 formulation guarantees great absortion.
  • Boswellia: it’s effective for psoriasis both as a cream and as pills. Together with curcumin it’s a very important supplement to take into account. We like to go for high doses rich in AKBA boswellic acids such as the ones provided by this supplement.

Recap of our recommendations for psoriasis and psoriatic arthritis:

  • Elimination diet followed by progressive reintroduction of foods. The most problematic ones are cereals, pulses, sugar, nightshades, eggs, red meats and nuts. Also add some fermented foods into your diet and watch the omega 3:6 ratio. Fish and seafood should definitely be in your diet, together with lots of vegetables and fruit. Reducing the intake of meat, especially red meat, should be taken into account due to it’s high content in arachidonic acid. A good read of Seignalet and Sarah Ballantyne’s books is no waste of time.
  • Enjoy daily sunshine and supplement with vitamin D in order to reach 60 ng/l.
  • Eat fish such as salmon, anchovies, mackerel or sardines and supplement with a high-quality omega 3 product.
  • External use of several products: coconut oil, tea tree oil, aloe vera and cannabis oil.
  • Combine two natural and well studied anti-inflammatories such as high absorption  BCM-95 formulations that have been enriched, for example these   curcumin extracts and  extracts of boswellia that are rich in AKBA.