Wednesday, May 25, 2016

Wisdom Wednesday: Psoriasis

Psoriasis is characterized by skin cells that multiply up to 10 times faster than normal. As underlying cells reach the skin’s surface and die, their sheer volume causes raised, red plagues covered with white scales. Psoriasis typically occurs on the knees, elbows, and scalp but it can also affect the torso, palms, and soles of the feet.

Psoriasis can also be associated with psoriatic arthritis, which leads to pain and swelling in the joints. Just imagine the joints going through the same chemical inflammation as the skin. The National Psoriasis Foundation estimates that between 10 to 30% of people with psoriasis also have psoriatic arthritis. Clinically, I find that number is closer to 30%.

I am of the opinion that psoriasis is an auto-immune disease and recent research indicates some abnormality in the immune is the key to the cause of psoriasis. Episodes can be triggered by emotional stress, trauma, and infection.

Injured skin and certain drugs can aggravate psoriasis, including some blood pressure medication (like beta-blockers), the anti-malarial medication hydroxychloroquine, and ibuprofen (Advil, Motrin, etc.)

Psoriasis tends to run in families, but it may skip generations.

I have used fish oil, an omega 3 fatty acid to treat psoriasis for over 30 years. It typically reduces the ugly red plague by 80-90% in a couple of weeks. I started using it long before I understood the prostaglandin inflammatory pathways that omega 3 fatty acids inhibit. I had been using fish oil to reduce LDL cholesterol and total cholesterol (back in the days when I thought that had value) when a few of my patients with psoriasis commented on their improvement. So the use was initially antidotal but later backed up by biochemistry.

Today we evaluate the prostaglandin, leukotriene and cytokine pathways to see what supplements will be most effective with patients suffering from psoriasis. Sometimes black current seed oil, sesame seed oil, ginger or Boswellia are more effective that fish or flax seed oil.

Dysbiosis or alternation in the GALT (gut associated lymphatic tissue) is the most typical cause. Removing offending foods (like wheat, corn, dairy, and/or soy) is often very beneficial as is restoring the microbiome. Often the use of a prebiotic can restore the normal microbial population of the gut. My favorite is Slippery Elm Bark. It is both anti-inflammatory and a food source for the healthy bacteria. The only contraindication for Slippery Elm Bark is SIBO (small intestinal bacteria overgrowth). In fact, I use Slippery Elm Bark as a simple test for SIBO. If a patient cannot tolerate Slippery Elm Bark, SIBO is a distinct possibility.

The Bottom Line:
If you suffer from psoriasis, try supplementing your diet with fish oil. I recommend four pearls per day to start. Once the skin clears, you can often reduce the dosage to two pearls per day. Make sure the brand you take has had the mercury removed. It should state so clearly on the label. Also review any medications you take, especially those noted above. Your PCP may be able to recommend an alternative medication that will not aggravate your skin.

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