Psoriasis is a chronic, autoimmune skin disease that causes skin cells to build up rapidly, resulting in redness, scaling, itchiness, dry skin and pain. These patches of inflamed skin are known as psoriasis lesions. They can appear anywhere on the surface of the body, though most often they show up on the scalp, knees and elbows. Like the other autoimmune conditions, the causes of psoriasis aren’t entirely clear but experts believe a combination of genetic predisposition and environmental trigger is in play.

Psoriasis can have a profound negative impact on quality of life not only because of its physical symptoms but also because lesions can be disfiguring. In a review of over 500 psoriasis patients, 73% reported that they felt stigmatised in some way because of their appearance. Psoriasis patients also report higher levels of anxiety, depression and suicidal thoughts than the general population, and the worse the severity of their psoriasis, the greater the burden on self-esteem, body image, psychological health, social life and overall quality of life.

Sadly, the emotional toll of psoriasis is only one aspect of its challenges. Psoriasis patients are also at greater risk of additional autoimmune illnesses, including rheumatoid arthritis, another form of arthritis known as psoriatic arthritis, and inflammatory bowel disease. But on top of it all, the risk of yet another autoimmune condition, celiac disease, is especially severe. Research suggests that having psoriasis roughly doubles the odds of being diagnosed with celiac disease. (Another study found the converse to be true, too: Having celiac disease significantly raises the risk of developing psoriasis.)

On a happier note, one study found that 42% of psoriasis in patients with celiac disease could be attributed to the underlying celiac disease, suggesting that for psoriasis patients with a gluten sensitivity, adopting a gluten-free diet may improve psoriasis symptoms. This is yet another instance of the healing power of eating for your particular body and your particular health profile. Many foods have different effects on different people. Use this knowledge to heal, rather than harm. 

Another way people with psoriasis may better control their symptoms is to lose any extra weight. That’s right—losing weight can improve your psoriasis and improve how you respond to medications. In one study, 60 obese patients with psoriasis were divided into either a weight loss group that ate 3,350 to 4,200 kilojoules a day for 8 weeks, followed by 8 weeks of no more than 5,000 kilojoules a day, or a control group. After 16 weeks, the weight loss group lost an average of nearly 15kgs, compared to less than 500g in the control group. Those in the intervention group also experienced an average change of −2.3 points in their Psoriasis Area and Severity Index (PASI) scores, a standard assessment of psoriasis activity, as opposed to just −0.3 in the control group. Researchers also noted that the greatest reduction in psoriasis severity occurred in the first half of the study, when the greatest weight loss occurred.

Researchers later conducted a follow-up study of this same group to observe the long-term effects of weight reduction, following the participants for an additional 48 weeks. Of the 32 people who completed the full course, average weight loss compared to original weight was just over 22 pounds and PASI scores were 2.9 points lower compared to the baseline. According to these results, long-term weight loss appears to keep psoriasis severity down for the long term.

Psoriasis is also associated with an increased risk of metabolic syndrome, high cholesterol, high blood pressure, and type 2 diabetes—conditions that help explain why psoriasis is strongly associated with a higher risk of heart attack and stroke. The association is so strong, in fact, that psoriasis is now classified as an independent risk factor for heart disease, as dangerous as smoking, excess weight, and diabetes.

What’s going on here? All of the coexisting conditions in psoriasis, from depression to celiac disease to cardiovascular illness, are linked by chronic inflammation. In study after study, researchers have observed that people with celiac disease and psoriasis also display signs of a leaky gut (intestinal permeability) brought about by inflammation. Obesity alone promotes a chronic inflammatory state and can lead to metabolic syndrome, as fat cells continually release a special type of cytokine known as adipokines and affect levels of leptin, the hormone that plays a role in controlling hunger.

It seems that psoriasis is associated with inflammation above and beyond other heart disease risk factors, and the worse the psoriasis, the worse the inflammation. Once you add depression into the mix (and remember, psoriasis patients have a higher risk of depression), the risk of heart disease rises. Psoriasis patients with a history of depression have higher inflammation and more plaque deposits in their arteries than those with no depression.

As inflammation is the common factor behind all these complications, taking measures to lower chronic inflammation can improve psoriasis symptoms and its complications. To this end, the National Psoriasis Foundation recommends an anti-inflammatory diet. Drawing on the principles of anti-inflammatory eating, below are some general guidelines to follow.

Foods to Avoid:

  • Fatty red meats
  • Dairy products
  • Processed foods (processed meats, bakery items, convenience foods, etc.)
  • Refined sugars
  • Nightshades (such as capsicums, white potatoes, eggplants and tomatoes, as some people have found that these foods can trigger flares)

Foods to Enjoy:

  • Fresh fruits and vegetables (organic is best to avoid pesticides)
  • Dark leafy greens (collards, broccoli, broccoli rabe, kale, spinach, bok choy, turnip greens, mustard greens, rocket, Swiss or rainbow chard, watercress, cabbage and chicory)
  • Foods containing vitamin D: fortified beverages (dairy or plant milks, orange juice), mushrooms, eggs, fish and fish oil
  • Calcium-rich foods (but make sure to avoid food triggers)
  • Foods that are rich in omega-3s: salmon, mackerel, herring, albacore tuna, walnuts, walnut oil, flaxseeds, flaxseed oil, olive oil, and pumpkin seeds
  • Probiotic-rich foods: fermented foods like sauerkraut, kimchi, buttermilk and kefir
  • Spices with an anti-inflammatory effect: turmeric, ginger, garlic, and black pepper
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