If you're a psoriasis sufferer, then you're already well aware that those red, itchy, and sometimes painful patches of scaly skin can be triggered by just about anything.
Skin injuries, cigarette smoking, illness, or changes in the weather are just a few things that are thought to provoke attacks, but what about food? Does your diet play a part in psoriasis flare-ups? And maybe more importantâ€”can changing it help prevent them?
The answer is: maybe.
Can what you eat improve or worsen your psoriasis symptoms?
Overall, the jury is still out on whether eating certain foods, or avoiding others, can have a significant impact on the frequency or severity of psoriasis.
"We do know that psoriasis has been linked to obesity," says Dr. Wentworth. "We often encourage weight loss for patients who are not at the weight that has been established as a goal for them with the assistance of their primary care provider."
Per the JAMA Dermatology review, psoriasis patients with celiac disease may find that avoiding foods containing gluten may be helpful in managing their symptoms. "We have done studies to show that if someone has celiac disease antibodies, a gluten-free diet could potentially benefit their psoriasis," says Dr. Wentworth.
But while there may not be one, cure-all, psoriasis treatment diet, evaluating what you eat is still a critical step in managing the disease says Victoria Yunez Behm, CNS, LDN, manager of nutrition science for the American Nutrition Association.
What to limit or avoid if you've got psoriasis
Because psoriasis is an immune-mediated disease, it's not just limited to the skin; it's systemic. So, Behm explains, it makes sense to choose foods that support your overall heath and avoid those that don't.
Here are a few to consider limiting in your diet:
Often loaded with sugar, sodium, and other additives, ultra-processed foods are high in saturated and trans fats, and should be avoided says Bridget Shields, MD, assistant professor, Department of Dermatology, University of Wisconsin- Madison.
According to a 2018 review in Current Obesity Reports, examples of ultra- processed foods include:
- pastries, cookies, and crackers
- ice cream
- processed meat
- breakfast cereal
- soft drinks
- prepared meals
Red meat and dairy
According to Dr. Shields, certain animal products, like red and processed meats and dairy, can be pro-inflammatory because they're high in trans and omega-6 fats and may be converted to an unsaturated fatty acid called "arachidonic acid."
"It is important to highlight that not all fats are created equal," she explains. "Omega-3 fatty acids, as found in mackerel, salmon, sea bass, hemp seeds, and chia seeds, are thought to be anti-inflammatory and omega-6 fatty acids may also have some beneficial systemic effects as well. The safest way to consume omega-6 fats is probably from whole foods, such as walnuts, sunflower seeds, and pumpkin seeds."
High-glycemic index foods
Certain high-glycemic foods may also "worsen psoriatic disease when eaten in large quantities for extended periods of time," says Dr. Shields ,and because of that, people with psoriasis may be better off avoiding them. Some examples of high-glycemic foods are:
- white bread
- white rice
- fruit juices (that don't contain fiber)
"Nightshades are a class of vegetables that some people can react to," Julie Zumpano, RD, a registered dietitian with the Department of Preventive Cardiology at Cleveland Clinic, tells ishonest. "Specifically for psoriatic arthritis, nightshades can be a trigger."
Nightshades contain alkaloids, a class of compounds primarily found in plants that can lead to psoriasis flare-ups, per Cleveland Clinic.
According to a small, national survey of psoriasis patients' dietary habits described in the journal Dermatology and Therapy, more than half of respondents reported skin improvements after reducing their intake of nightshade veggies.
Examples of nightshades include:
- potatoes (excluding sweet potatoes)
- peppers (hot and sweet)
- certain spices made from peppers (cayenne, paprika)
What to eat if you have psoriasis
While there's no single, "best" diet for psoriasis, a Mediterranean diet is not a bad choice.
Dr. Shields cites large trials demonstrating a wealth of benefits for people following a Mediterranean diet, including reductions in markers of inflammation, decreased body weight, and lower insulin production. "All factors that should, in theory, benefit patients with psoriasis," she says.
Zumpano says that the Mediterranean diet is a good diet to try, but like anything, suggests giving it a month or two to see how you respond. "There's trial and error," she says. "So, if you're going to try a diet to 'cure your psoriasis,' I would do a very whole foods, heavily-plant-based, clean diet, then I would track your flare-ups and see if there was anything in your diet that may have stimulated it."
Here are some foods to include in your diet:
Omega-3 fatty acids
The upside for people with psoriasis? Behm says numerous clinical studies confirm the benefits of omega-3s for reducing inflammation that accompanies immune-mediated inflammatory diseases like psoriasis.
Foods's high in omega-3s include:
- flax seed
- chia seeds
Fruits and vegetables
"Vegetables are excellent anti-inflammatory foods, as are many fruits, especially those that are on the lower glycemic index and have higher fiber content," says Dr. Shields.
Behm recommends getting creative and eating a "rainbow of fresh plant foods each day," especially the colorful ones, which contain phytonutrients, or compounds that have anti-inflammatory and antioxidant properties. Examples include:
- dark, leafy greens
- yellow beets
- pumpkin, and other winter squashes
- purple carrots
"It's important to note that as we are learning more and more about psoriasis, we are learning it can be linked to things like diabetes, high blood pressure, high lipids, or fats in the blood," says Dr. Wentworth.
- coconut oil
- cold-pressed extra virgin olive oil
- low-mercury, wild- caught fish like wild Alaskan salmon
When it comes to those proteins, Behm suggests opting for "high-quality" sources, whether they're animal or plant-based. Examples of proteins include:
- cage-free eggs
- wild fish
- nuts (almonds and walnuts)
- fatty fish, like salmon, mackerel, and tuna
Vitamin D is the main ingredient in two, topical prescription medications for psoriasis, and according to Dr. Shields, they work well in helping treat the skin. Based on that, it seems logical that taking vitamin D as an oral supplement could also benefit sufferers. Unfortunately, there's not a lot of research to back the theory.
"If you look at the data [for] vitamin D supplementation in psoriatic patients, we really don't have good evidence that high-dose vitamin D supplementation is helpful," says Dr. Shields.
That said, however, it may be beneficial to add it to your diet naturally and according to the National Psoriasis Foundation, the safest way to do that is through food. Good sources of vitamin D include:
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