Reply To: 64 yo F – Obesity, diabetes, psoriatic arthritis, IBS, hypothyroidism

[Christine Bailey]

Dear Shoshana,

Many thanks for your question about your client with psoriatic arthritis, diabetes and IBS symptoms. You also mentioned she is taking various medications for raised cholesterol and blood pressure. It is encouraging that she has already seen improvements in terms of weight loss and blood sugar control. However, you have mentioned that the arthritis and psoriasis has worsened.

Psoriasis is a systemic inflammatory disorder that generally comprises excessive production of skin cells leading to patches of thick, scaly, inflamed, often itchy skin. The systemic inflammation underlying psoriasis can also manifest as psoriatic arthritis, which can be a severe arthritic joint condition. It is worth noting that those with psoriasis have a markedly increased risk of developing other major inflammatory disorders, particularly:

cardiovascular disease

diabetes

metabolic syndrome

stroke

 

In view of her health issues this is particularly relevant. Nutrients such as fish oil, vitamin D, and pycnogenol have potent anti-inflammatory properties and have been shown to alleviate symptoms of psoriasis.  There are also lifestyle interventions to recommend. A Mediterranean-style diet reduces the severity of psoriasis, with higher consumption of olive oil and fish associated with lower psoriasis severity. Climatotherapy and balneotherapy, the medical use of mineral water and mud baths, are shown to be beneficial in psoriasis.

Good sleep hygiene is helpful, as nighttime melatonin levels are significantly lower in psoriasis patients. In view of her stress levels this may be particularly relevant -if cortisol is high at night then it can interfere with the production of melatonin.

Chronic sleep deprivation impairs the skin’s integrity, weakens its function as a protective barrier, and exacerbates the inflammation of psoriasis.

Oyetakin-White P, Suggs A, Koo B, Matsui MS, Yarosh D, Cooper KD, Baron ED. Does poor sleep quality affect skin ageing? Clinical and experimental dermatology. Jan 2015;40(1):17-22. https://tinyurl.com/y9jfjqt2

 

These are the nutrients I would particularly look to include:

Fish oil: Fish oil supplements given to psoriasis patients for up to six months resulted in clinical improvement in skin redness, hardening, scaling, and itching.

Fish oil supplements (up to 13.5 g eicosapentaenoic acid [EPA] and 9 g docosahexaenoic acid [DHA] daily) given to psoriasis patients for up to six months resulted in clinical improvement in skin redness, hardening, and scaling, and some studies found a benefit for itching.

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. 04/26 2014;71(3):561-569.  https://tinyurl.com/y8rc3sjm

 

Vitamin D: In a 2013 study, psoriasis symptoms significantly improved in patients receiving high daily doses of vitamin D3 in combination with a low-calcium diet.

While topical synthetic forms of vitamin D (analogs) are used in the conventional treatment of psoriasis, multiple studies have demonstrated that the natural form of vitamin D3 (cholecalciferol), which can be taken orally, may be a safe and effective psoriasis treatment.

Kim GK. The rationale behind topical vitamin d analogs in the treatment of psoriasis: where does topical calcitriol fit in? The Journal of clinical and aesthetic dermatology. Aug 2010;3(8):46-53. https://tinyurl.com/y9ojuebc

 

Zinc: The essential mineral zinc plays an important role in maintaining a healthy immune response. Zinc modulates production of inflammatory cytokines such as IL-2 and IL-6. In a study in mice with induced psoriasis, injections of zinc into the abdominal cavity mitigated oxidative stress and caused a significant decrease in elevated serum levels of inflammatory IL-2.

Yin LL, Zhang Y, Guo DM, et al. Effects of zinc on interleukins and antioxidant enzyme values in psoriasis-induced mice. Biol Trace Elem Res. 2013;155:411-415.  https://tinyurl.com/y74v5qug

 

Pycnogenol: In a placebo-controlled clinical trial in psoriasis patients, the addition of 50 mg of pycnogenol three times daily to standard treatment resulted in significant improvement in skin redness, hardening, and scaling compared with standard treatment alone.

Belcaro G, Luzzi R, Hu S, et al. Improvement in signs and symptoms in psoriasis patients with pycnogenol supplementation. Panminerva Med. 2014;Mar;56(1):41-8. https://tinyurl.com/ybv9cstv

 

Curcumin: owing to its anti-inflammatory properties as well as its ability to inhibit excessive new growth of cells and blood vessels, curcumin has promise as a potential therapy in the treatment of psoriasis.

Chen ZQ, Mo ZN. [Curcumin in the treatment of prostatic diseases]. Zhonghua nan ke xue = National journal of andrology. Jan 2008;14(1):67-70.  https://tinyurl.com/y6vd3d6f

 

Probiotics: An altered microbiota is a factor in the initiation and promotion of immune-mediated inflammatory diseases, including inflammatory bowel disease. Both psoriasis and psoriatic arthritis have been associated with inflammatory bowel disease. It has been suggested that the microbiota may play a key regulatory role in the inflammatory pathways shared by these diseases.

Li WQ, Han JL, Chan AT, et al. Psoriasis, psoriatic arthritis and increased risk of incident Crohn’s disease in US women. Ann Rheum Dis. 2013;72(7):1200-1205. https://tinyurl.com/ybd4q8be

 

Whey protein: in one study, administration of whey protein isolate over three months resulted in clinical improvement in patients with psoriasis, regardless of whether the whey protein was given alone or in addition to topical or light therapies.

Prussick R, Prussick L, Gutman J. Psoriasis improvement in patients using glutathione-enhancing, nondenatured whey protein isolate: a pilot study. J Clin Aesthet Dermatol. 2013;6(10):23-26. https://tinyurl.com/ycy5ehfn

 

I would also check homocysteine levels, because this is an independent risk factor for cardiovascular disease and possibly Alzheimer’s disease and this is often elevated in patients with psoriasis.

Some studies have reported that psoriasis patients have lower levels of the B vitamin folate, which is essential in the breakdown of homocysteine. In one case-control study in patients with chronic plaque psoriasis, high plasma homocysteine correlated with increased disease severity and low levels of folate.

Malerba M, Gisondi P, Radaeli A, et al. Plasma homocysteine and folate levels in patients with chronic plaque psoriasis. Bt J Dermatol. 2006;155(6):1165-9.  https://tinyurl.com/y83bz99t

 

Boswellia serrata gum resin extracts have been used in traditional Ayurvedic medicine, and are now being investigated and used for the treatment of chronic inflammatory diseases such as rheumatoid arthritis and inflammatory bowel disease. Boswellic acids, the active components of the Boswellia serrata resin, exert anti-inflammatory effects primarily through inhibition of the proinflammatory enzyme 5-lipoxygenase (5-LOX).

Togni S, Maramaldi G, Di Pierro F, Biondi M. A cosmeceutical formulation based on boswellic acids for the treatment of erythematous eczema and psoriasis. Clinical, Cosmetic and Investigational Dermatology. 11/11/2014;7:321-327. https://tinyurl.com/y8jkc2l5

 

As psoriatic arthritis is considered to be an auto immune condition I would look for underlying triggers – gut health is especially relevant here and in view of her bacterial dysbiosis and candida I would consider including some gut anti-microbial support for this client and support the health of the gut lining with fermented foods, bone broth, adding in turmeric to the diet and looking a supplements such as colostrum and collagen. Vitamin A and D are equally important for innate immune health and may also alleviate some of the symptoms of psoriasis too.

While psoriasis involves multiple genes, a variant gene called HLA-Cw6 appears to confer the greatest risk. This gene is part of a family of genes, referred to as the HLA complex, that is strongly associated with common autoimmune diseases including type 1 diabetes, celiac disease, and multiple sclerosis. In view of this I would suggest a gluten free diet and low carbohydrate diet in view of her diabetes.

A 2014 review concluded that a gluten-free diet may benefit psoriasis patients who have elevated celiac disease antibodies. In some cases, complete clearance of psoriatic skin was reported following a gluten-free diet.

Bhatia BK, Millsop JW, Debbaneh M, et al. Diet and psoriasis: part 2. celiac disease and role of a gluten-free diet. J Am Acad Dermatol. 2014;Aug;71(2):350-358. https://tinyurl.com/hvttte6

 

SUGGESTED SUPPLEMENTS

The following supplements are suggested for you to consider in light of your relevant expertise and intimate understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.

Anti-microbial support

ADP Oregano (BRC) – take 2-3 with each meal – https://tinyurl.com/hdjg9c5

Innate immune support

Saccharomyces boulardii (ARG) – take 1 twice daily – http://tinyurl.com/z27sdwn

Vitamin D3 Complete (ARG) – take 1 daily – http://tinyurl.com/jqx3ttt

Lower inflammation and gut support

Arthred Collagen Powder (ARG) – take 1tbsp three times daily – https://tinyurl.com/j2arfe4

Phospholipid colostrum (ARG) – take 1tbsp three times a day – https://tinyurl.com/zwty66b

OcuDyne II (ARG) take 2 twice daily – multi with anti-oxidants and includes methyl folate – https://tinyurl.com/z4ndrzx

Aller Aid L92 (ARG) – contains 265mg of boswellia together with Lactobacillus and vitamin C to modulate TH1/TH2 – take 1 twice daily

Nordic Naturals Cod Liver Oil lemon soft gels – take 3 daily

 

I hope this helps with your client

Christine