Diet for Psoriatic Arthritis: what to Eat and Avoid

Arthritis refers to a set of conditions that are characterized by joint pain and inflammation. There are many different types of arthritis.

The most common types include:

  • osteoarthritis
  • rheumatoid arthritis
  • fibromyalgia
  • psoriatic arthritis

Psoriatic arthritis is a type of chronic arthritis that occurs most often in people with the skin condition psoriasis.

Like other types of arthritis, psoriatic arthritis affects the major joints of the body. These joints can become inflamed and painful. If left untreated for a long period of time, they can become damaged.

For people with inflammatory conditions, eating certain foods may either lower inflammation or cause even more damage.

Research suggests that specific dietary choices can help reduce disease severity in psoriatic arthritis.

Here are some suggestions on foods to eat, foods to avoid, and various diets to try for the management of your psoriatic arthritis.

Foods to eat when you have psoriatic arthritis

Anti-inflammatory omega-3s

For people with psoriatic arthritis, anti-inflammatory foods are an important part of potentially reducing painful flare-ups.

Omega-3 fatty acids are a type of polyunsaturated fatty acid (PUFA). They have been studied extensively because of their anti-inflammatory properties.

One study involving people with psoriatic arthritis looked at the use of omega-3 PUFA supplementation over a 24-week period.

The results showed a decrease in:

  • disease activity
  • joint tenderness
  • joint redness
  • over-the-counter pain reliever use

Alpha-linolenic acid (ALA) is a type of omega-3 that’s mostly plant based and considered essential. The body can’t make it on its own.

ALA must convert to EPA or DHA to be used. EPA and DHA are two other important types of omega-3s. Both are plentiful in seafood.

The conversion rate from ALA to EPA and DHA is low, so it’s important to eat plenty of marine omega-3s as part of a well-rounded diet.

The best food sources of omega-3s include:

  • fatty fish, such as salmon and tuna
  • seaweed and algae
  • hemp seeds
  • flaxseed oil
  • flax and chia seeds
  • walnuts
  • edamame
High-antioxidant fruits and vegetables

In people with certain diseases, such as psoriatic arthritis, chronic inflammation can damage the body.

Antioxidants are compounds that reduce the harmful oxidative stress from chronic inflammation.

A 2018 study found that many people with arthritis have a low antioxidant status. Lack of antioxidants was linked with increased disease activity and disease duration.

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There are plenty of naturally occurring antioxidants in food sources.

Fill your shopping basket with fresh fruits, vegetables, nuts, and spices. And no need to skip the espresso — coffee beans are a great source of antioxidants!

The best food sources of antioxidants include:

  • dark berries
  • dark, leafy greens
  • nuts
  • dried ground spices
  • dark chocolate
  • tea and coffee
High-fiber whole grains

Obesity is a risk factor for psoriasis, which makes it a risk factor for psoriatic arthritis as well.

One of the most common conditions associated with obesity is insulin resistance. Long-term blood sugar problems cause insulin resistance, most often from an unhealthy diet.

Research suggests that there’s a link between obesity, insulin resistance, and chronic inflammation. For people with psoriatic arthritis, weight management and blood sugar management are crucial.

Unprocessed whole grains contain plenty of fiber and nutrients and are digested more slowly. This helps to avoid insulin spikes and keep blood sugar at a healthy level.

Some of the best food sources of whole grains are:

  • whole wheat
  • corn
  • whole oats
  • quinoa
  • brown and wild rice

Foods to limit when you have psoriatic arthritis

Red meat

Diets high in red meat and processed meat products have been suggested to play a role in weight gain and inflammation.

In a large cohort study conducted in 2017, a high intake of fatty red meat was associated with a higher body mass index (BMI) in both men and women.

As the researchers noted, a high BMI is associated with negative changes in the hormones that manage hunger and insulin secretion.

Only eat red meat occasionally and try to increase consumption of:

  • chicken
  • fatty or lean fish
  • nuts
  • beans and legumes
Dairy

Food intolerances and allergies activate the immune system and can cause low- grade, chronic inflammation in the gut.

A small 2017 study also found that people who consumed a high-dairy diet for 4 weeks had higher insulin resistance and fasting insulin levels.

Low-fat dairy in moderation is healthful if you don’t have an intolerance or allergy.

However, if you’re concerned about your body’s reaction to dairy, try the following instead:

  • almond milk
  • soy milk
  • coconut milk
  • hemp milk
  • flax milk
  • plant-based yogurts
Processed foods

Processed foods and drinks are high in excess sugar, salt, and fat. These types of food are linked to inflammatory conditions such as:

  • obesity
  • high cholesterol
  • high blood sugar levels

In addition, many processed foods are cooked using omega-6-rich oils such as:

    corn
  • sunflower
  • peanut oil

Omega-6 fatty acids demonstrate a pro-inflammatory pattern, so it’s important to keep their consumption at a reasonable level.

What to eat instead:

  • fresh fruits
  • fresh vegetables
  • whole grains
  • unprocessed lean meats

Diet types to consider

Some people tout certain diets as being beneficial for health conditions. Here we take a look at several popular diets and how they may affect psoriasis and psoriatic arthritis.

Note that the approach of these diets vary widely — some even provide conflicting guidance. As well, there is limited evidence that these diets actually improve psoriatic arthritis.

Keto diet

The link between the ketogenic diet, or keto diet, and psoriatic arthritis is still evolving. The low-carb, high-fat diet can be helpful to some in losing weight, which is a factor in reducing symptoms.

Some research indicates this diet may have anti-inflammatory effects. However, other research shows mixed results for the diet’s effect on psoriasis.

More studies are needed to determine whether people with psoriatic arthritis might benefit from the keto diet.

Good high-fat options to include on a keto diet aiming for weight loss and less inflammation include:

  • salmon
  • tuna
  • avocados
  • walnuts
  • chia seeds
Gluten-free diet

A gluten-free diet isn’t necessary for everyone with psoriatic arthritis.

However, a review of studies suggests that people who have psoriasis tend to have a higher prevalence of celiac disease (although research results are mixed on this).

Testing can determine if you’re sensitive to gluten.

For people with a sensitivity to gluten or who have celiac disease, a gluten- free diet can help to reduce the severity of psoriatic flare-ups and improve disease management.

Paleo diet

The paleo diet is a popular diet that emphasizes choosing foods similar to what our ancestors would have eaten.

It’s a back-to-basics (like prehistoric basics) approach to eating. The diet advocates eating foods like those hunter-gatherer ancestors used to eat.

Examples of food choices include:

    nuts
  • fruits
  • veggies
  • seeds

If you do eat meat, try to choose lean meats over fatty red meats. There’s a link between red meat, inflammation, and disease. It’s also recommended that you try to choose meat from free-range and grass-fed animals.

A 2016 analysis of available research shows that in many clinical studies, the paleo diet had positive benefits.

It was commonly associated with improvements in BMI, blood pressure, and blood lipid levels, particularly within the first 6 months of following the diet.

Researchers haven’t performed a large-scale study about the paleo diet and psoriatic arthritis.

However, according to the National Psoriasis Foundation, researchers have indicated that certain diets, including the paleo diet, have the potential to reduce weight. This in turn may help improve psoriatic arthritis symptoms.

Mediterranean diet

The Mediterranean diet has long been called one of the healthiest diets in the world. This diet is high in fresh fruits, vegetables, nuts, whole grains, and oils. Red meat, dairy, and processed foods are rarely eaten.

A 2017 study found that people with osteoarthritis who followed to a Mediterranean diet for 16 weeks experienced weight loss and reduced inflammation.

A cross-sectional study conducted in 2016 reported that those who stuck more closely to a Mediterranean-style diet also benefitted from decreased arthritic pain and disability.

Low-FODMAP diet

The low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet is one that healthcare providers often recommend in the treatment of irritable bowel syndrome (IBS).

While there isn’t a lot of specific research regarding the low-FODMAP diet in regard to psoriatic arthritis, studies have indicated a positive link between psoriatic arthritis and IBS.

The diet involves avoiding or limiting certain carbohydrates in a wide range of foods known to cause gas, diarrhea, and stomach pain.

Examples include wheat, legumes, various fruits and vegetables, lactose, and sugar alcohols, such as sorbitol.

Studies of people with IBS who followed a low-FODMAP diet have found that they have fewer episodes of abdominal pain and bloating.

Leaky gut diet

The concept of a leaky gut has increased in attention over the past few years. The idea is that a person with a leaky gut has increased intestinal permeability.

In theory, this increased permeability allows bacteria and toxins to pass more easily into your bloodstream.

Although many mainstream healthcare providers don’t recognize leaky gut syndrome, some researchers have identified that a leaky gut may increase the risks for autoimmune and inflammatory disorders.

While there isn’t an official “leaky gut diet,” some of the general recommendations include eating:

  • gluten-free grains
  • cultured dairy products (such as kefir)
  • sprouted seeds such as chia seeds, flax seeds, and sunflower seeds
  • healthy fats such as olive oil, avocado, avocado oil, and coconut oil
  • nuts
  • fermented vegetables
  • beverages such as kombucha and coconut milk

Foods to avoid on a leaky gut diet include those with wheat and other grains that have gluten, dairy products, and artificial sweeteners.

Pagano diet

Dr. John Pagano created the Pagano diet to help his patients reduce the incidence of psoriasis and eczema. He wrote a book called “Healing Psoriasis: The Natural Alternative” describing his methods.

While the diet is geared toward psoriasis and eczema, these are both inflammatory conditions much like psoriatic arthritis.

In a national survey on dietary behaviors, those who followed the Pagano diet reported the most favorable skin responses.

Principles of the Pagano diet include avoiding foods such as:

  • red meat
  • nightshade vegetables
  • processed foods
  • citrus fruits

Instead, Dr. Pagano recommends eating lots of fruits and vegetables, which he says are alkaline-forming foods that help reduce inflammation in the body.

AIP diet

The autoimmune protocol (AIP) diet is a form of elimination diet designed to reduce inflammation in the body. While some people say it’s like a paleo diet, others may find it more restrictive.

A small 2017 study involving people with inflammatory bowel disease (IBD) found the AIP diet helped reduce stomach symptoms.

The diet includes a long list of foods to avoid, such as:

  • grains
  • dairy products
  • processed foods
  • refined sugars
  • industrial-made seed oils

The diet mostly involves eating meats, fermented foods, and vegetables, and because it is an elimination-focused diet, it isn’t intended to be followed long term.

DASH diet

The Dietary Approaches to Stop Hypertension (DASH) is a diet that healthcare providers traditionally recommend to enhance heart health and limit sodium intake.

However, researchers have studied the diet’s potential benefits in helping those with gout, another arthritis form. They found following the diet reduced serum uric acid, which can contribute to gout flare-ups.

Examples of DASH diet guidelines include eating six to eight servings of whole grains a day while also eating fruits, vegetables, lean meats, and low-fat dairy. The diet also involves eating less than 2,300 milligrams of sodium per day.

This diet is very different from many of the anti-inflammatory diets because it doesn’t restrict wheat or dairy. If you haven’t responded to those diets and wish to try a different approach, the DASH diet may help.

Takeaway

For people with psoriatic arthritis, a healthy diet can help with symptom management.

Fruits and vegetables rich in antioxidants and other nutrient-dense foods may help to decrease inflammation.

Choose a dietary pattern that decreases the risk of weight gain, insulin resistance, and other chronic conditions.

Discussing these options with your healthcare provider and seeking the advice of a dietitian can help you take first steps in managing your psoriatic arthritis.

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