Psoriasis – and General AutoImmune Considerations

(This is a sample entry from our Q&A Treasure chest, a database with hundreds of entries to support students with their patient and client work.  Unlimited access is included as part of our Core 101 Semester program.)

Student Question:

My client has terrible psoriasis on legs, arms, head, behinds and now new break outs on lower back and has been seeing dermatologist for her outbreaks for many, many years.  She’s been on all the creams, lotions and potions and also does the UV light treatments in the doc’s office, but none of the physicians she’s seen so far are focused on root cause assessments.  What are the links between food and psoriasis that you know of (no surprise that no practitioner has mentioned food yet) and what about autoimmune considerations?  What are tools to educate my client?   Thanks!

SAFM Response:

Great question!  Psoriasis is an autoimmune type of illness in which the immune system causes cells called keratinocytes to overproduce new skin cells.  The result is scaly, dry skin patches which can occur almost anywhere on the body.   It is an inflammatory process in which the immune system (specifically T-cells) secretes cytokines which confuse the cells into this overproduction, especially via Th-17.

Lipopolysaccharide-driven inflammatory/autoimmune activity via enhanced intestinal permeability is often involved in psoriasis.  We are learning more and more in clinical research about the role of translocation of microbial DNA in promoting chronic autoimmune activity, including that of psoriasis.  Research demonstrates higher levels of LPS in these patients’ bloodwork  and topical support (or even phototherapy) is not going to alleviate this driver.  Because of the “leaky gut” aspect,  foods such as gluten, dairy, and perhaps other grains (often cross-reactive with wheat/gluten) are typically involved in exacerbating inflammatory behavior.  At least short-term (4-6 mos) avoidance of exacerbating foods is helpful (and perhaps longer depending on duration of the healing process).  But getting to the true root causes of her unique case of intestinal permeability and healing the gut are both crucial for sustainable improvement.

In terms of client education… You might be interested in this excellent general post on the topic  from Dr. Mark Hyman for a broad introduction and discussion of common drivers.  This is an easy-to-follow article in this vein  from Chris Kresser that might be inspiring to your client and which also lists some general applicable-to-all suggestions.  Dr. Alessio Fasano has completed ground-breaking research to demonstrate that intestinal permeability – and thus likely gluten sensitivity – is a part of the trigger for autoimmune disease activation.  This is an online video you may desire to share with more savvy clients.  Or for an appreciably more savvy client (and you as well), I would consider this write-up.

Many factors can contribute to intestinal permeability, and this topic is covered in depth in our Disease Begins in the Gut 101 clinical course. It is well understood that poor bile function is involved in many cases of psoriasis too, not surprising give the role of bile in breaking down LPS to minimize systemic reactivity in the presence of leaky gut.  This is a related post in our SAFM Clinical Tip area which will interest you about the value of bile acid support for these patients.   Research has also begun to explore specific differences in the microbiome of psoriasis patients.

Hydration and appropriate balances in pro-inflammatory and anti-inflammatory dietary fats are also key for overall skin health and minimizing the severity of dis-ease of the skin.  Psoriasis has been shown to respond dramatically to omega-3 supplementation (3-4g/day).  There is also often improvement when addressing impaired digestion, especially impaired protein digestion (low stomach acid?  e.g. check albumin, globulin, ferritin, serum B12) and/or (as above) bile acid insufficiency (think thoroughly about possible connections… e.g. no gallbladder, history of gallstones, high alkaline phosphatase, high fecal fats on stool test or lighter-colored stools which consistently float).

Now, let’s talk more generally about the functional medicine concepts and interconnectedness likely involved in chronic autoimmune activity…  In my experience, autoimmune triggers are usually multifaceted and include some or all of the following:

1. Dysbiosis – or imbalance – of microbes in the gastrointestinal tract (may be something infectious like simmering Clostridia, yeast overgrowth, a parasite, or simply an insufficiency of or imbalance in indigenous gut bacteria).  One of the major drivers for dysbiosis is antibiotic use, especially multiple extended courses over time.   But medications, toxins, stress, food choices, low Vitamin D, and many other factors may be involved.  A comprehensive, DNA-assay stool test such as a GI Map can help to characterize what is at play specifically.
2. Food sensitivities.  As you know, I disagree with this client’s MD, as food triggers are very, very often involved in autoimmune activation and exacerbation.  In my experience both gluten and dairy are the most common triggers, and thus, a thorough food elimination experiment can be very helpful (must be cold-turkey, full elimination to be effective though, not just reduction!).  This is a detailed write-up on food sensitivities.  To allow food sensitivities from leaky gut to heal, it is necessary to repair the gut lining using key nutrients such as l-glutamine, Vitamin D, glycine, quercetin, and/or mucilaginous herbs (e.g. slippery elm, okra, marshmallow).
3. Toxin build-up, caused either by ongoing exposure (overload) and/or poor detoxification ability of certain substances (e.g. mercury)
4. Nutrient deficiencies that impair the immune system or detoxification (e.g. vitamin D, zinc, copper, Vitamin A, folate (B9), B12).  These might be driven by insufficient nutrient intake, impaired gastrointestinal digestion and/or absorption, or genetic variability in cellular use of nutrients (e.g.  individuals positive for the GSTM1 or MTHFR gene variants (that is, “SNP”s  in which someone has poor glutathione synthesis or a methylation (detox processes) issue due to enzyme impairment).
5. Stress.  Ongoing, chronic or short-term acute stress can trigger immune system over-activation and is usually involved on some level in autoimmune activation.  This stress might be mental-emotional or it might be physiological (e.g. prior surgery, major car accident or other physical trauma, other autoimmune activation, pathogenic microbe, toxicity, chronic viral infection).
6. Impaired cortisol secretion where the body has insufficient cortisol to bolster the immune system and supply our own anti-inflammatory defense mechanism (evidence of adrenal “fatigue”, unfortunately quite common in overworked, fatigued Americans, especially those with persistent viral infections or food sensitivities which further stress adrenal function on a day-over-day basis)
7. Self-rejection in the mind where the body is mirroring the negative intentions of the heart or negative beliefs.  A perfect example of the power of the mind-body-spirit connection.
8. Genetic predispositions may also be involved, though these are often related to the above items (e.g. impaired detoxification or low Vitamin D receptor activity) vs. being a singular, genetic driver for the autoimmune activity itself.