Expert perspectives: Anti-inflammatory diet for psoriasis

As Desiree Nielsen, a registered dietitian based in Vancouver, British Columbia, explained: “An anti-inflammatory diet is one that is built on a foundation of [nutrient-dense] whole-plant foods, like:

• vegetables
• intact whole grains
• nuts
• seeds

These foods offer nutrition to support the immune system.”

“They also offer a ton of fiber, which is critical for supporting a healthy gut barrier and microbiome, two factors that help keep inflammation at bay,” Nielsen added.

However, it is important to note that the relationship between gut bacteria and inflammation is complicated. Simply adding more fiber to the diet will not necessarily reduce inflammation.

“Of course, as we eat more whole plants, we will probably eat fewer hyper-processed foods [also called ultra-processed foods] as a result,” Nielsen observed.

“Eating too many hyper-processed foods, specifically those high in salt, sugar, or saturated fat and low in fiber, is detrimental to the gut microbiome and gut health in general. [But] these foods aren’t harmful in small amounts — a dietary pattern is far more powerful than a single plate.”

“I do see that skin conditions such as psoriasis are supported by a move toward an anti-inflammatory diet, but unfortunately, we don’t yet have a lot of clinical research specifically on anti-inflammatory diets as a whole for those with psoriasis,” Nielsen acknowledged.

However, “One study found that following a Mediterranean diet was associated with less severe psoriasis,” she noted.

Dr. Peter Lio, a dermatologist practicing in Chicago, IL, and a professor of dermatology at Northwestern University, in Evanston, cautioned, “My clinical experience tells me that there are two important caveats to [following an anti-inflammatory diet for psoriasis].”

“The first is that it is not totally consistent. I have some patients who see changes with diet, but I also have a large group that really has not seen much improvement after significant dietary changes.”

“The second caveat is one of magnitude. While some patients certainly see dramatic improvement [in psoriasis] with dietary change, in my personal experience, the changes tend to be much more modest,” Dr. Lio reported.

“I think we still have a lot to learn about this area, and the truth is that there is probably not a ‘universal explanation,’ since we know that different people have different experiences with foods,” Dr. Lio explained.

“Heavily processed foods may trigger inflammation via changing the microbiome of the gut. We now know that our microbiome is important for overall health and has many effects on our immune system.”

“Sugary foods, including simple carbohydrates that have a high glycemic index [score], raise blood sugar, which not only can be directly damaging to our organs but also then results in an insulin spike. This has an effect on lots of different inflammatory pathways.”

“Part of the effect is likely due to the fact that being overweight clearly contributes to inflammation in the body, and there is a well-accepted relationship between obesity and psoriasis,” Dr. Lio noted.

“While I do think that weight loss itself can be an important factor for psoriasis and inflammation in general, any of the well-accepted anti-inflammatory diets also seem to have additional advantages — based on what a person is actually eating as opposed to simply being fewer calories,” he added.

“I would recommend reliable sources such as the Mayo Clinic and Johns Hopkins’ patient educational resources and would caution people from reading testimonials or [trusting] online fad diets,” recommended Lakshi Aldredge, MSN, ANP-BC, DCNP, a nurse practitioner practicing in Portland, OR, and president of the Society of Dermatology Nurse Practitioners.

“These [suggestions from unreliable sources and fad diets] can be harmful and lead to worsening health issues,” she warned.

“There is not one perfect diet that I know of, and there is a great deal of discussion and controversy in this area, it is important to point out,” added Dr. Lio.

“I think it is important to work with a registered dietitian, to help with the specifics and to make sure that the diet is balanced, suitable, and most importantly, something that [an individual] can sustain.”

“My favorite way to [recommend starting an] anti-inflammatory living is to make half the plate vegetables at lunch and dinner,” suggested Nielsen. “It is a great place to start because it does not require a person to drastically change how they eat, and it allows the body to slowly adapt to extra fiber.”

“Good nutrition should always be individualized to a person’s needs, but the basics of eating whole-plant foods and drinking plenty of water apply to all,” she explained.

“Working with a nutritionist or dietician can be very helpful,” noted Aldredge, who added, “Having a trained professional who can work with the person to develop a diet plan that incorporates their dietary desires and modifying to a healthy diet can help with adherence and successful outcomes.”

“We live in an immediate gratification world, and it leads us to try all manner of quick-fix diets,” Nielsen observed. “I really encourage people to go slow — perhaps choose two to three initial goals, such as drinking more water or making half the plate vegetables — and ensure that the changes work for their lifestyle, so they will actually stick.”

“This is about progress, not perfection,” she added.

There is evidence that an anti-inflammatory diet may help some people with psoriasis. A person can discuss the best ways to change their diet with a registered dietician or certified nutritionist.

Medications are a key part of psoriasis management, but a healthy lifestyle is also important in managing psoriatic disease. According to experts, this may include:

• managing stress
• getting regular exercise
• having a low-glycemic, low-processed diet that includes foods in the Mediterranean diet