Can an Anti-Inflammatory Diet Prevent Psoriasis Flare-Ups?
“Should I change my diet?” It’s one of the most common questions floating around the psoriasis community. And it seems like everyone has an opinion about it. Some people say that eliminating gluten reduces the severity of their flares. Other people may tell you it’s the alcohol or red meat that has to go. The most common recommendation may be to stick to an anti-inflammatory diet. But what actually works? Here, we give you a full rundown of what we know and don’t know about the effects of an anti-inflammatory diet on psoriasis and psoriatic arthritis.
The Connection Between Diet and Inflammation
We know that psoriasis is an inflammatory disease. And we know that when inflammation levels rise, this increases the likelihood of a psoriasis flare. We also know that the foods we eat can impact the amount of inflammation (or inflammatory cytokines) in our bodies. So, it seems logical that eating an anti-inflammatory diet could reduce the likelihood of a flare-up.
Some foods, like processed meats, are considered pro-inflammatory; while others, like berries, are considered anti-inflammatory. An anti-inflammatory diet is both high in anti-inflammatory foods and low in pro-inflammatory foods. And it seems to reduce the frequency and severity of psoriasis flare-ups in some people. However, there is no direct scientific evidence (yet) that anti-inflammatory diets work.
What the Science Says
According to the National Psoriasis Foundation, the only official dietary recommendation for people with psoriasis is for folks who are overweight or obese. To help them lose excess weight, NPF recommends a low-calorie diet.
Tina Bhutani, M.D., co-director of the Psoriasis and Skin Treatment Center at the University of California San Francisco, explains why weight loss is so important.
“Adipocytes, which are the fat cells in the body, produce the same sort of inflammatory cytokines that drive psoriasis,” says Bhutani. “By decreasing those fat cells, we are decreasing overall inflammation.”
What the Science Doesn’t Say
We currently don’t we have firm science on whether an anti-inflammatory works to ease psoriasis. But why? Think about it this way: Would you be willing to check into a hospital for eight weeks and let scientists prepare all your food for you? Probably not! Due to the complex nature of clinical trials, prescribed-diet studies are very hard to conduct.
Even if scientists could get people to volunteer, you would have to repeat the study several times to figure out exactly what was making a difference—the absence of red meat, the extra berries, the extra omega-3s, and so on. All this is to say that science may very well support the idea of an anti-inflammatory diet—it just hasn’t been proven in clinical trials.
What the Doctors Say
Dermatologists hear all sorts of anecdotal reports on what works and doesn’t work for their patients. Some doctors, like Susan Bard, M.D., dermatologist from Vive Dermatology in Brooklyn, NY, do recommend an anti-inflammatory diet to their patients.
“I counsel my patients a lot about anti-inflammatory diets,” says Bard. “Not that this is going to be the ‘make it or break it’ for them. It’s not going to cause their psoriasis to go into remission and that will be the end of it. But every little contribution that you make helps.”
Other doctors, like Bhutani, believe it’s a bit more complicated than making a universal recommendation.
“I think it comes back to the genetics of the disease,” says Bhutani. “Even if you have, let's say, five patients in a room that all have psoriasis, they probably have a different genetic makeup. So, if I give all five patients one diet, it might work for one patient, but it's not going to work for all five of them.”
According to Bhutani, there may be no magic diet that works for everyone, but there may be one that works for you. You might use the anti-inflammatory diet as a guide, then work out the specifics for yourself.
How to Adopt an Anti-inflammatory Diet
Starting a new diet is never easy, but the anti-inflammatory diet does leave you with a fair amount of options.
“I recommend a diet rich in antioxidant-rich fruits and vegetables, plant-based oils like olive oil, as well as fatty fish like salmon, trout, and tuna for those with inflammatory skin conditions like psoriasis,” says Staci Gulbin, M.S., MEd, R.D., a licensed dietician. “I would also recommend a diet low in potentially inflammatory foods, like foods containing added sugar, processed meats, and red meat.”
It helps to make a plan for how you might replace pro-inflammatory foods with healthier alternatives. For example, if you eat a ham and cheese sandwich for lunch every day, consider switching to sliced turkey from the deli on whole grain bread or a lettuce wrap. You can substitute sugary drinks with seltzer water and fresh fruit. For dinner, avoid red meat by having chicken or fish instead of steak and using plant-based meat substitutes for ground beef.
Some people with psoriasis and psoriatic arthritis also say they find benefits in eliminating specific foods they suspect are triggers for their flare-ups. Common triggers are:
- nightshades (tomatoes, eggplant, peppers, potatoes)
You can experiment with eliminating some of these common triggers to see if your symptoms improve.
Tips for Changing Your Lifestyle
If you have trouble adhering to strict diets, know that your anti-inflammatory diet doesn’t have to be an all-or-nothing situation. Try sticking to it as much as possible and save the inflammatory foods you love for special occasions.
You may also want to consider an elimination diet. During an elimination diet, you eliminate all possible triggers from your diet for two to three weeks and watch for improvement. Then slowly start adding back the foods, one at a time, to see if they trigger your symptoms.