Dietary Modifications

With gluten-free diets getting more and more attention these days, you may wonder if going gluten-free would help reduce your psoriasis symptoms.

The jury is still out on eliminating gluten — a complex protein found in wheat, barley, and rye. In a small number of cases, eliminating gluten can lead to improvements. However, following a gluten-free diet, which is very restrictive, is a major commitment. It’s not a step you should take unnecessarily.

You should discuss dietary modifications, such as following a gluten-free diet, with your health care provider prior to making any diet adjustments. 

To understand why — and if — eliminating gluten might be right for you, it’s important to understand why and how gluten can cause problems for some people.

• Gluten allergy: Experts estimate that up to 2 million people in the U.S. may suffer from an allergy to gluten, which is found in bread, pasta, crackers, and other baked goods made from wheat, barley, or rye. Less obvious are processed foods, from lunch meats to salad dressings, that can also contain this potentially problematic family of proteins.
  
  A gluten allergy means that the body forms antigens in response to a protein in gluten, activating an immune system response and possibly also spurring any immune-system disorder, such as psoriasis, in the process.
  
  Common symptoms of a gluten allergy include diarrhea, bloating, headaches, canker sores, fatigue, irregular menstrual cycles in women, joint pain, and sleep problems.
  
• Celiac disease: A gluten-free diet is the only known treatment for this autoimmune disease, a digestive disorder that can damage the small intestine. A simple blood test can help screen for it.
  
  Some experts suspect that psoriasis, an immune-mediated disease, may share a connection with celiac disease. Other experts believe that the two conditions are not directly connected, but rather that a subset of people with psoriasis also happens to have celiac disease or gluten intolerance.

There are individuals with gluten sensitivity and those with celiac disease. Both require the elimination of gluten from your diet. You may want to talk with your health care provider about an elimination diet or a blood test to screen for celiac disease.

While a gluten-free diet may not be the answer for everyone, if you are one of those individuals who are sensitive to gluten, it may make a noticeable difference for you.

With a dramatic increase in the diagnosis of celiac disease and gluten intolerance in recent years, mainstream grocery stores, restaurant chains, and bakeries are introducing more and more gluten-free products.

Following a gluten-free diet requires you to become educated on all the hidden sources of gluten, as well as educating loved ones. To avoid all gluten, you must read labels carefully (and regularly, because manufacturers can change ingredients without notice). You need to avoid not only wheat but its derivatives: durum, graham, kamut, semolina, and spelt. The same goes with barley derivatives: malt flavoring and malt vinegar, as well as rye, MSG, and soy sauce. Remember, just because a food is labeled wheat-free doesn’t mean it’s gluten-free.

Some manufacturers add sugar, saturated fats, and preservatives to their gluten-free offerings to make them taste better, but they also add calories. Just because a diet is gluten-free it does not mean it’s calorie-free. You still need to apply the principles of a balanced diet.

On the other hand, says Jerry Bagel, M.D., director of the Psoriasis Treatment Center of Central New Jersey in East Windsor and a member of the National Psoriasis Foundation medical board, if someone’s skin improves as a result of a gluten-free diet, it’s likely the patient’s digestive system is improving as well and absorbing more nutrients.

Gluten-free diets allow you to still eat all fresh fruits and vegetables, which should be part of your healthy diet. Beef, chicken, fish, lamb, pork, and dairy products are also naturally gluten-free. Again, just be sure to watch for additives.

If you try a gluten-free diet, it can take several months for the inflammation to subside. It is recommended that you remain completely gluten-free for at least three months, being sure to remove all sources of gluten from your diet. After three months, if you are unsure if you’ve seen a benefit from eliminating gluten, try adding it back into your diet. Over the next three to four days be sure to make note of increased itching, joint pain, headaches, etc. If you don’t notice any benefit, you may choose to add gluten back into your diet permanently.

Talk to your doctor or a nutritionist before your try a gluten-free diet.

• Gluten Intolerance Group
• Celiac Disease Foundation

Psoriasis is a systemic inflammatory disease, as is heart disease, so reducing inflammation and improving heart health is important for individuals with psoriasis.

Consider these recommendations:

• Eat fish at least twice a week. Research shows that eating cold-water fish containing omega-3 fatty acids (for example, salmon, trout, and herring) can help lower your risk of coronary artery disease.
• Choose lean meats and poultry without skin. Prepare them without adding saturated and trans-fat. Baking and broiling are heart-healthy ways to prepare lean meats and poultry.
• Use fat-free, 1-percent fat, and low-fat dairy products.
• Limit foods containing partially hydrogenated vegetable oils to reduce trans fat in your diet.
• Aim to eat less than 1,500 milligrams of sodium per day. Read food labels to see how much you’re consuming.
• Limit alcohol. Individuals with more severe psoriasis may benefit from eliminating alcohol entirely. If you are going to have an occasional drink, it is recommended that women should not exceed one drink per day and men should drink no more than two drinks per day.
• Keep an eye on your portion sizes. Consider weighing and measuring your food until you get used to the appropriate portion size.
• Limit the amount of processed and fast food you eat.

• The American Heart Association
• Centers for Disease Control

As mentioned, inflammatory immune-mediated diseases, like psoriasis, increase your risk for other health complications. Being overweight further compounds your risk for diabetes and heart disease.

To minimize your risk of these related diseases, it’s important to maintain a healthy weight.

To help identify what is a healthy weight for you, calculate your body mass index (BMI). You can use this calculator from the Centers for Disease Control.

To lose weight, you need to burn more calories than you consume. People who lose weight slowly, about 1 to 2 pounds per week, are more successful at keeping the weight off. You also will burn additional calories if you increase your physical activity.

Your weight loss plan should:

• Emphasize fruits, vegetables, whole grains, and fat-free or low-fat dairy products.
• Include lean meats, poultry, fish, beans, eggs, and nuts.
• Contain foods low in saturated fats, avoid trans fats, and limit cholesterol and salt (sodium).
• Avoid refined sugars and processed foods.

• Keep a food diary. Studies have shown that writing down everything you eat is a critical part of sustained weight loss. Noting how you feel when you eat will help you identify emotional triggers that may cause you to overeat.
• Eat slowly. If you eat too fast, you eat more than you need to satisfy your hunger. Your brain needs time to catch up with your stomach.
• Plan your meals ahead of time so you make healthy choices. When dining out, check the menu online and decide what you will order ahead of time. Ask for dressings on the side and opt for foods that are baked, broiled, or steamed versus foods that are fried or in creamy sauces. Avoid the chips and bread baskets that can add unnecessary calories to a meal.
• Eat when you’re truly hungry rather than when you are tired, anxious, or stressed. Emotional eaters tend to overeat.
• Stay hydrated. Oftentimes people mistake thirst for hunger.
• Eat breakfast. If you skip this meal, you’ll be starving by lunchtime and will have more difficulty making healthy choices throughout the day.
• Find resources to help you keep track of your food choices and nutritional values, and that can offer additional support when you need it. Potential resources include CalorieKing.com and MyFitnessPal.com, which offer a searchable database of foods with nutritional values.

If you are overweight, talk to your doctor about a weight loss approach that is right for you. 

Omega-3 fatty acids have been shown to decrease inflammation, and psoriasis is a disease of inflammation. Omega-3 fatty acids also seem to have a positive impact on the body’s immune system.

Types of omega-3 fatty acids:

• Alpha-linolenic acid
• Eicosapentaenoic acid (EPA)
• Docosahexaenoic acid (DHA)

Alpha-linolenic acid is found in some vegetable oils, nuts, seeds, and soy foods. EPA and DHA are found in fatty fish and algae. Fish oil is readily available in capsule form as a supplement. Some individuals with psoriasis show a deficiency of omega-3 fatty acids and elevations of omega-6 fatty acids, which tend to increase inflammation.

The research on whether omega-3 fatty acid supplements can help reduce the severity of psoriasis is mixed. More long-term clinical controlled studies are needed.

Fish oil can thin your blood, so check with your doctor before you start taking it, especially if you are taking Coumadin (warfarin) or other blood thinners.

Vitamin D topical ointments have been around and used to treat psoriasis for some time. Vitamin D is the main active ingredient in two prescription medications – Vectical and Dovonex – which are applied to the skin. Vitamin D can change the way cells grow. Psoriasis increases the growth of the skin’s cells. Vitamin D may slow skin cell growth.

Research on whether vitamin D can help alleviate psoriasis symptoms is small and limited.

Too much vitamin D can be dangerous. Before you add vitamin D to your psoriasis regime, talk with your doctor. The safest source of vitamin D is food.

Food sources of vitamin D include:

• Cod liver oil
• Salmon (sockeye)
• Mackerel
• Tuna fish canned in water
• Milk (non-fat, reduced-fat, and whole) vitamin D-fortified
• Orange juice fortified with vitamin D
• Yogurt fortified with 20 percent of the daily value of vitamin D
• Eggs (vitamin D is found in the yolk)
• Swiss cheese
• Vitamin D-fortified cereals

You also can get vitamin D from 10 minutes of mid-day exposure to the sun. However, prolonged sun exposure has been linked to skin cancer and is not recommended.

A simple blood test can tell you whether you’re deficient in vitamin D. If you are concerned, talk with your doctor.

Glucosamine and chondroitin are dietary supplements that can be bought over the counter and can be taken individually or together. Glucosamine and chondroitin occur naturally in and around the cells of the body’s cartilage. Glucosamine is thought to help in cartilage formation and repair and may inhibit inflammation. Chondroitin is thought to promote cartilage elasticity and inhibit the breakdown of cartilage.

A growing body of research shows that these supplements may slow the progression and reduce the pain of osteoarthritis, a degenerative disease characterized by cartilage deterioration of the joints. However, psoriatic arthritis (PsA) and osteoarthritis are different forms of arthritis and have different symptoms. No studies have found that glucosamine and/or chondroitin supplements effectively reduce symptoms of PsA.

Glucosamine contains substances extracted from animal tissue including shrimp, lobster shells, and shark cartilage. People who are allergic to shellfish should avoid glucosamine. Also, children and women who are pregnant or plan to become pregnant should not take these supplements.

Glucosamine can increase blood sugar levels in diabetic patients. If you have diabetes, talk with your doctor before taking glucosamine supplements.