Psoriasis & SIBO

Did you know that skin issues are typically a result of some sort of digestive dysfunction?  That’s right…your acne, psoriasis, itchy skin, rashes, eczema, and/or rosacea could indicate that there is something going awry in your gut.

I remember going to a dermatologist when I was younger for issues like acne, severely itchy skin, and psoriasis only to be offered harmful treatments like antibiotics and invasive topical creams.  Never was it mentioned that changing my diet and treating my digestive issues would have an impact.  Much less the HUGE, lasting impact that it has had.

In this post, I will share with you all about psoriasis as well as discuss its connection to diet and digestive health.

Psoriasis 101

Psoriasis is a common inflammatory autoimmune skin condition impacting between 2 and 4% of individuals in Western society.  The condition appears to impact both men and women equally and the average age of onset is 33 years old.

The condition is characterized by red, thickened patches on the skin covered with white or silvery scales.  These typically occur on the scalp, elbows, knees and/or back.  Rashes, itching, and nail abnormalities are other symptoms seen in those with psoriasis.  Additionally, about one-third of individuals with psoriasis will eventually develop psoriatic arthritis.

A common pharmaceutical remedy for psoriasis is the administration of immunosuppressants.  However, this is not always necessary, especially if symptoms are minor.  As many as 30% of individuals with psoriasis experience spontaneous remission.

Psoriasis Risk Factors

A variety of risk factors have been identified that may increase your likelihood of developing this condition:

• Family history (30% have a 1st or 2nd degree relative with psoriasis)
• Diet (see below)
• Obesity
• Smoking
• Stress
• Alcohol consumption
• Infections (such as HIV and beta-hemolytic streptococcal)
• Drugs (such as beta blockers, lithium, antimalarial drugs)
• Vitamin D deficiency (lower rates of psoriasis in warm, sunny climates)
• Celiac disease
• Caucasian descent

Psoriasis has also been associated with a variety of conditions such as metabolic syndrome, cancer, Crohn’s disease, type 2 diabetes, depression, vitamin B12 deficiency, and increased risk of cardiovascular (heart) disease.  In fact, the National Psoriasis Foundation recommends screening individuals as young as age 20 years old for risk factors of cardiovascular disease if they have psoriasis.  Along these same lines, lab values that are often abnormal in psoriasis patients include increased CRP (a marker of overall inflammation in the body), decreased blood folate, elevated homocysteine, and dyslipidemia.

Psoriasis and Diet

The connection between psoriasis and diet has been addressed in the scientific literature since at least the 1970s.  It has been proposed that a variety of antioxidants and nutrients may be helpful for individuals with psoriasis.  Some examples include omega-3 polyunsaturated fatty acids, vitamin A, vitamin C, vitamin D, vitamin E, iron, copper, manganese, zinc, and selenium.  Eating a balanced diet rich in vegetables, low-mercury fatty fish, nuts, and seeds can help supply adequate amounts of these nutrients.

A study also found that individuals who consumed a more Mediterranean-style diet had lower rates of psoriasis.  Specifically, the study found that individuals without psoriasis typically consumed less red meat and more fruit, nuts, extra virgin olive oil, and fish than individuals with psoriasis.  I predict that the benefit of the Mediterranean diet for individuals with psoriasis is likely due to its anti-inflammatory effects.

A commonality between the remedies addressed above is the inclusion of fish in the diet.  Logically, that makes fish oil a key possibility for relieving psoriasis.  A review article on psoriasis revealed that 12 out of 15 studies into the benefits of fish oil for psoriasis showed a reduction in symptoms.

Interestingly, another dietary remedy that has been shown to reduce psoriasis symptoms is fasting.  Perhaps this has something to do with calming the immune system.

Psoriasis and Celiac

A variety of studies have found that individuals with psoriasis have an increased risk (greater than 2 times) of developing Celiac disease.  Conversely, those with Celiac disease also have an increased risk of developing psoriasis.  Even for individuals without Celiac disease, removing gluten from the diet may provide dramatic improvement.

Psoriasis and SIBO

A small research study was conducted that looked at malabsorption in individuals with psoriasis.  First, the 55 participants were tested for malabsorption using a d-xylose breath test.  Those who tested positive were then examined for SIBO, Celiac, and a few other digestive conditions.  For SIBO testing, the researchers utilized a lactulose hydrogen breath test (meaning they tested for hydrogen only, not methane).  A test was considered positive for bacterial overgrowth if the hydrogen level reached at least 20 ppm over the baseline reading.  21% of the those with psoriasis and malabsorption tested positive for SIBO.  If they had also tested for methane gas, it is possible that the percentage would have been even higher.

Although there is only limited research available regarding a connection between psoriasis and SIBO, my personal experience with these conditions makes it very clear to me that there is one.  Improvement in my digestive symptoms is associated with reduced psoriasis patches on my elbows.  Specifically, it seems that when my symptoms of intestinal permeability (leaky gut) are reduced, so is my psoriasis.  Since psoriasis is an autoimmune condition and leaky gut is believed to be a necessity for an autoimmune condition to develop, this phenomenon makes sense.

Do you have anything to share about SIBO & Psoriasis?  I would love to hear your experience with these conditions in the comment section below!

References:

Barrea L, Balato N, Di Somma C, et al. Nutrition and psoriasis: is there any association between the severity of the disease and adherence to the Mediterranean diet? Journal of Translational Medicine. 2015;13:18. doi:10.1186/s12967-014-0372-1.

Millsop JW, Bhatia BK, Debbaneh M, Koo J, Liao W. Diet and Psoriasis: Part 3. Role of Nutritional Supplements. Journal of the American Academy of Dermatology. 2014;71(3):561-569. doi:10.1016/j.jaad.2014.03.016.

Katta R, Desai SP. Diet and Dermatology: The Role of Dietary Intervention in Skin Disease. The Journal of Clinical and Aesthetic Dermatology. 2014;7(7):46-51.

Bhatia BK, Millsop JW, Debbaneh M, Koo J, Linos E, Liao W. Diet and Psoriasis: Part 2. Celiac Disease and Role of a Gluten-Free Diet. Journal of the American Academy of Dermatology. 2014;71(2):350-358. doi:10.1016/j.jaad.2014.03.017.

ARAUJO, Maria Lúcia Diniz; BURGOS, Maria Goretti P. de A.  and  MOURA, Isis Suruagy Correia. Nutritional influences in psoriasis. An. Bras. Dermatol. [online]. 2009, vol.84, n.1, pp. 90-92.

Traub M, Marshall K. Psoriasis–pathophysiology, conventional, and alternative approaches to treatment. Altern Med Rev. 2007;12(4):319-30.

Abenavoli L, Leggio L, Gasbarrini G, Addolorato G. Celiac disease and skin: Psoriasis association. World Journal of Gastroenterology : WJG. 2007;13(14):2138-2139. doi:10.3748/wjg.v13.i14.2138.

Ojetti V, De Simone C, Aguilar Sanchez J, et. al. Malabsorption in psoriatic patients: Cause or consequence? Scandinavian Journal of Gastroenterology. 2006; 41: 1267-1271.