Though many patients find that certain diets help clear their skin, or that certain foods aggravate it, no studies have established a definitive link between nutrition and psoriasis, says Neil Korman, MD, clinical director of the Murdough Family Center for Psoriasis in Cleveland Heights, Ohio. “There’s no ‘Psoriasis Diet,’ but people with psoriasis should try to eat a healthy diet,” he says. “We do know that people who are obese are at increased risk for psoriasis, and that losing weight may help improve your psoriasis.”
“Achieving a healthy weight and eating more healthfully in general” are the goals when working with psoriasis patients, says Brenda Walsh, RD, an outpatient clinical dietitian at the Murdough center. Psoriasis is an inflammatory disease, she says, and “we know that weight loss can decrease levels of C-reactive protein (CRP), which is produced by the body in response to inflammation.” Increasing activity levels and dropping pounds can help lower CRP levels.
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What should you eat?
Emphasizing foods that contain antioxidants, such as fruits, vegetables, whole grains, and beans, which can reduce inflammation, may also help, says Deirdre Earls, RD, a dietitian in private practice in Austin, Texas.
A chronic psoriasis sufferer herself, Earls says she has had minimal outbreaks since she started following a diet based on the University of Michigan Integrative Medicine Clinic’s Healing Foods Pyramid six and a half years ago. The diet has also helped her patients, Earls reports.
Even if you can’t make all the changes, small tweaks (eating more vegetables, trading white bread and rice for whole grains, eliminating processed food) can improve your health. “Proceed at your own pace and focus on the positive choices you make,” advises Earls.
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Fruits and vegetables
How much: Two to four servings of fruits and a minimum of five servings of vegetables (or more if you want) every day.
Why: Fruits and vegetables are loaded with antioxidants that help control inflammation naturally, says Earls.
“I recommend my patients select a variety of deeply pigmented fruits and vegetables when choosing antioxidant-rich foods,” says Walsh. “Some examples are red bell peppers, pineapple, spinach, raspberries, blueberries, and carrots. I always recommend obtaining antioxidants from food, rather than in supplement form. This allows you to obtain all the benefits available in that food, not simply what happens to be extracted and packaged into a pill.”
What's a serving: One apple, orange, or medium banana; 3/4 cup of berries; 1/2 cup of raw or cooked vegetables.
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How much: Four to 11 daily servings of grains, preferably whole grains (whole-grain bread, cereal and pasta, oatmeal, and brown rice).
Why: Whole grains contain a variety of inflammation-fighting antioxidants, says Earls. They are also high in fiber, which is associated with decreased inflammation levels.
What’s a serving: One slice whole-grain bread, 1/3 cup pasta, 3/4 cup cereal, 1/3 cup rice.
Beans and lentils How much: One to three servings a day of beans, peas, lentils, or peanuts.
Why: They are all great sources of protein, and also contain tons of antioxidants and have high levels of fiber.
What’s a serving: 1/2 cup cooked beans or lentils.
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How much: One to two servings a day of edamame, soy milk, soy nuts, and tofu.
Why: A number of studies have linked decreased inflammation with eating soy, says Earls. In addition, soy is an excellent source of protein and contains isoflavones, which are thought to help reduce inflammation.
What’s a serving: 1/2 cup edamame, 1 cup soy milk, 1 ounce soy nuts, 1/2 cup tofu.
Fats How much: Three to nine daily servings of olive oil, peanut oil, canola oil, nuts, avocado, seeds, or nut butters.
Why: Good fats can help the body fight inflammation. But avoid margarine and shortening that contain trans fats, which can have the reverse effect.
What’s a serving: 1 teaspoon of oil, 1/2 tablespoon nut butter, 2 walnuts.
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Fish and seafood
How much: Two to four servings per week, with an emphasis on fish with a high omega-3 fatty acid content (salmon, anchovies, mackerel, tuna, and sardines, especially wild varieties).
Why: There is strong evidence that omega-3s help reduce inflammation, says Earls. If you’re not a fish eater, you may want to consider an omega-3 supplement. She recommends two high-quality brands: Pharmax and Nordic Naturals.'
What’s a serving: 4 to 6 ounces of fish.
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What should you limit?
Foods that may contribute to inflammation should be eaten in more limited quantities or eliminated. These include processed and fast food, foods that are high in saturated and trans fats, and refined starches and sugar.
"When you have an inflammatory condition, it's especially important to avoid fatty meats and fried foods, which promote inflammation," says Michael Traub, a naturopathic physician in Kailua Kona, Hawaii. "If you’re eating them once a month, that's probably OK. But once a week is not."
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How much: Eat up to three 2- to 3-ounce servings per week, choosing lean cuts such as white-meat chicken or turkey, flank steak, sirloin, or pork loin. Higher-fat cuts contain more saturated fat, which may contribute to inflammation.
Sugar How much: Try to avoid sweets as much as possible. “Sugar promotes inflammation in the body,” says Traub.
Alcohol How much: Limit your intake as much as possible, at least until symptoms clear. Although the exact mechanism remains unknown (inflammation is one possibility), alcohol is believed by some to trigger psoriasis outbreaks.
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The gluten connection
Some researchers believe that there may be an increased frequency of celiac disease among people with psoriasis, explains Earls. People who have celiac disease cannot properly digest a protein called gluten that’s found in wheat, rye, and barley. Eating these foods can damage the lining of the small intestine, often resulting in chronic diarrhea as well as malnutrition. (Some people with celiac disease have no symptoms, though.)
If you believe that gluten intolerance may be an issue for you, ask your doctor if you should be screened for celiac disease. If you are gluten intolerant, your psoriasis may improve if you follow a super-strict gluten-free diet (avoiding anything containing wheat, rye, or barley). “It does take real commitment,” says Earls. “But what was disabling psoriasis (for me) has been in remission for six years without any negative side effects."