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If you’ve got psoriasis – there’s a pretty big chance that you’re deficient in certain nutrients (especially if your psoriasis is more severe).
In fact, nutrient deficiencies are more common than you probably think!
As a clinical nutritionist, I often find that those with more severe symptoms tend to experience higher degrees of nutrient deficiencies (which is one reason that I do not understand the resistance to checking the nutrient status of those with psoriasis).
So let’s discuss which key macro and micronutrients are commonly found to be deficient in psoriasis and what that could mean for your body and health!
Especially because nutrient deficiencies are a source of intense stress because your body doesn’t have the proper nutrients to operate efficiently.
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In this episode:
- Common nutrient deficiencies found in cases of psoriasis
- Impacts of low protein intake on psoriasis cases (that I see in my practice)
- Why this one key macronutrient is so important
- Certain optimal ranges that I use in my clinical practice
- What selenium has to do with psoriasis
- The potential impact several of these nutrients have on modulating your immune response
Quotes:
There’s no way you can know that your nutrient stores and nutrient intake are appropriate for you without (in many instances) looking at labs.
Keep in mind that combining several interventions together may make a bigger impact on your skin than a single intervention alone.
259: Common Nutrient Deficiencies in Psoriasis {RESEARCH} (FULL TRANSCRIPT)
Welcome back to episode #259 of the Healthy Skin Show!
In today’s episode, I’m going to share some interesting research with you about crucial nutrient deficiencies that are commonly found in those with psoriasis.
This is a big deal because what’s in your diet AND what your body can actually digest and absorb are crucial to good health.
Your body generally doesn’t make all the nutrients it needs to thrive which is why you need to consume them in appropriate amounts which may vary from person to person based on a variety of factors including genetics, stress, medication depletions, infections, etc.
And while eating your nutrients from food-based sources is ideal, it may not be enough depending on your individual need, current nutrient stores, and your gut’s ability to extract and absorb those nutrients from food.
Another factor I should mention is the well-established connection between psoriasis (and psoriatic arthritis), inflammatory processes, and other inflammatory conditions such as liver disease, cardiovascular disease, diabetes, Hashimoto’s thyroiditis, Inflammatory Bowel Disease, and more. I’ve discussed many of these topics on the Healthy Skin Show.
This is why having an ample supply of nutrients for your body to use to do SO MANY THINGS is crucial because it’s under even more stress with everything it’s facing.
As a clinical nutritionist, I often discover that most of my psoriatic clients struggle to know what to eat (due to the many iterations of elimination diets) that also won’t cause a flare. About 75% of the time, my psoriasis clients also struggle with chronic gut issues as well which have been normalized by their doctor as “IBS.”
That said, it’s not necessary to have IBS symptoms like gas, bloating, constipation, heartburn, or diarrhea to also have hidden problems residing within the GI tract.
This is a huge misconception that misleads people to think that their gut is fine because they poop like a champ one to three times a day and eat a nutritious diet.
Take it from me – there’s no way you can know that your nutrient stores and nutrient intake are appropriate for you without (in many instances) looking at labs (more on this later).
So let’s talk about the current research demonstrating that the following nutrients appear to be suboptimal (or deficient) in those with psoriasis: (1)
- Omega-3 Fatty Acids
- Vitamin D
- Vitamin B12
- Fiber (especially the fermentable kind also known as FODMAPs)
- Selenium
- Protein
Psoriasis + Omega 3 Fatty Acids
To kick things off, the connection of Omega-3 fatty acids to psoriasis should really be rather straightforward since we know that Omega-3s help with inflammation (remember that psoriasis has a huge inflammation component).
The inflammation produced in psoriasis results in a variety of elevated cytokines which can trigger all sorts of symptoms (this is why biologic drugs work since they block them).
Omega-3s may support blocking the Th-17 response as well as reducing cytokines associated with psoriasis including IL-17, IL-23, and TNF-a.(1,2)
Omega-3s can be found in a variety of foods including: (3,4)
- Wild-caught coldwater fish like salmon + cod
- Ground flaxseeds + cold-pressed flax oil
- Raw walnuts
- Chia seeds
- Oysters
- Grass-fed + finished beef (which I have found can be a healthy option eaten 1-2x/week for a number of my psoriasis clients)
- Certain algae (which is what vegan Omega-3 supplements are derived from)
This all said, don’t go into increasing your Omega-3 intake hoping that it will be THE THING to make your psoriasis disappear. It’s certainly a factor often in a much bigger picture of dysfunction under the surface.
When researchers looked at the impact of Omega-3 supplementation on those with psoriasis – they didn’t find any impact at all and concluded that it’s not worth doing.(5)
However as a clinical nutritionist looking at the picture of what’s going on in your psoriasis case from several different perspectives, we often need to combine several interventions together to make an impact that individually might not get your results.
Psoriasis + Vitamin D
Vitamin D deficiency is fairly common in many chronic skin issues including psoriasis.
It’s something that we assess all clients for and hope to see their Vitamin D level in the more optimal range between 60-80 ng/mL.
This optimal range is considerably higher than what’s often accepted as normal – which is anything over 30 ng/mL.
Vitamin D modulates the immune response and has been shown to reduce keratinocyte proliferation and can lower certain inflammatory cytokines associated with psoriasis including TNF-a.(1)
Some research has looked at what I’d consider a very high megadose of Vitamin D ranging from 30,000 to 60,000 IU daily for a limited period which appeared to show helpful results.(6) Before giving this a try on your own, I’d recommend working with a practitioner who is extremely knowledgeable in high megadoses of nutrients + can review appropriate labs so your levels can be monitored to avoid possible side effects. Again, this is not something I’d recommend trying on your own, but it is certainly something you can bring to your practitioner.
Though sun exposure can trigger the endogenous production of Vitamin D in the skin, dietary sources of Vitamin D are just as important because many people limit sun exposure (sometimes just purely because of working inside).
And many live in areas where the sun intensity drops for about half of the year to a point where sun exposure cannot appropriately trigger vitamin D production in the skin.
Diet sources include “cod liver oil, swordfish, salmon, tuna, sardines, beef liver, egg, or cheese.” (1) And vitamin D supplements are typically derived from cod liver oil, lanolin derived from wool, or lichen (which is the vegan source of Vitamin D).
I’ve also shared on the Healthy Skin Show the benefits of considering a topical Vitamin D cream. Just be aware that this will impact body stores and should be monitored just as you would oral supplementation.
Psoriasis + Vitamin B12
Another commonly low nutrient that I see in my practice is Vitamin B12 which often is due to a hidden H.pylori infection.
That said, B12 is important for several reasons including energy production, protection of the myelin sheath, and is helpful against oxidative stress. It’s also a crucial nutrient along with folate and vitamin B6 in reducing homocysteine which is considered by conventional medicine to be a marker for cardiovascular risk.(7)
As a clinical nutritionist who often sees insufficient nutrient stores in clients – Vitamin B12 levels should be significantly higher than what is deemed acceptable by conventional standards. I’ve had many clients experiencing significant Vitamin B12 deficiency symptoms despite their level hovering in the 300s pg/mL which is considered normal.(8)
Typically I prefer a client’s B12 to be around 800 pg/mL for optimal health.
That said, B12 must be balanced with folate so before you start supplementation, get labs run on both since these nutrients go hand-in-hand in producing healthy red blood cells.
Healthy food sources are typically limited to animal products including meat, liver, eggs, milk, and seafood as well as nutritional yeast which is vegan.(9)
Though I’ve talked about topical Vitamin B12 used for eczema, there is research published in 2017 demonstrating that it may also be helpful for psoriasis.(10)
Psoriasis + Fiber Intake
Diet is commonly something that does require tweaking to some degree depending on what you're currently eating. Though not everyone diagnosed with psoriasis is consuming a processed diet, another common issue is low fiber intake.(1)
While a processed diet would certainly limit fiber intake, those with IBS symptoms (especially if they’re dealing with looser stools) might intentionally avoid fiber to help manage their gut symptoms.
This is another reason why gut issues should be assessed in psoriasis cases since gut involvement is a well-established connection to this condition.
When I say fiber, I’m more specifically talking about FODMAP fibers which are fermentable fibers found in certain foods. These fibers become food for your healthy gut bacteria to ferment and essentially convert into something called Short-chain Fatty Acids (or SCFAs for short).
Short-chain Fatty Acids are crucial to support a healthy large intestine especially because the major SCFA called Butyrate helps to secure the junctions between colon cells. What this means is that it helps to keep the spaces between your gut’s cells very tight to avoid leakiness (aka. Leaky gut).
Additionally, research demonstrates that Butyrate also may be able to help stabilize and regulate keratinocyte activity (which is helpful for those dealing with psoriasis where keratinocytes tend to overproliferate contributing to skin plaques).(1,11)
As for intake, my recommendation is to shoot for 35 grams of fiber daily. It’s easier to do when fiber is spread out throughout the day and eaten with each meal. Healthy FODMAP foods include asparagus, avocado, berries, onions, garlic, cruciferous veggies, and legumes. The list is pretty lengthy – incorporate in high FODMAP foods since that’s where the fiber is!
However, if these FODMAP foods trigger IBS symptoms like gas and bloating or cause gut discomfort or diarrhea, this is a sign of bacterial overgrowth within the GI tract. I’d recommend getting help from a nutrition professional who is skilled in identifying what’s going on so that you can eventually tolerate these healthy foods again.
Psoriasis + Selenium
Selenium is an important micronutrient that is most commonly associated with proper thyroid health since it’s a necessary cofactor for the conversion of inactive thyroid hormone (T4) to its active version (T3).
Low levels also seem to be found in those with psoriasis which also correlated to the severity of one’s condition – so the worse your psoriasis symptoms are, the lower the selenium level in your body. This has led researchers to conclude that the sufficiency of this mineral may have some protective effect in terms of psoriasis.(12)
Though I was unable to find research to connect the two issues – I do feel it’s worth mentioning that those with psoriasis have an increased risk of also developing Hashimoto’s thyroiditis and thus struggling with thyroid problems. I’ve witnessed the havoc that both of these conditions together can wreak on clients (here’s one client’s personal story).
So clinically it didn’t surprise me when I came across research that mentioned the association found between insufficient selenium and psoriasis.(1,12,13)
Food sources of selenium include brazil nuts, organ meats, meat and shellfish.(14) The amount of selenium found in brazil nuts, by the way, is rather astounding – you really only need to eat one or two nuts a day (you read that right!) to get a sizeable dose of selenium.
Psoriasis + Protein Intake
If you know anything about me, you know how much I believe protein intake is crucial for chronic skin issues – especially psoriasis!
Research underscores that this important macronutrient is commonly low in the diet of those with psoriasis AND I can confirm that is pretty common to see in my clinical practice.(1)
We often encourage clients to increase protein intake quite drastically especially if we see other issues in their case –
- poor thyroid function
- gastrointestinal complaints
- low digestive enzyme output (from the pancreas)
- suboptimal or low secretory A production in the GI tract (this is incredibly common)
Your body should not tap into muscle for its protein (or amino acid) needs.
Doing so can cause muscle wasting and lead to other problems in the body. If you have thought that you have plenty of muscle such that you don’t need as much protein in your diet (thinking that muscle is a protein storage site) – think again!
When protein intake isn’t sufficient, a lot of things can suffer including:
- Body composition – as you can’t increase muscle mass within an influx of amino acids (and this is a red flag if you’re losing weight)
- Thyroid function because thyroid hormone is made with the amino acid tyrosine
- Your mood since amino acids help to form neurotransmitters (like serotonin) that support how your body experiences stress and anxiety
- Liver detoxification (specifically in Phase 2) slows down adding to the backup of toxins that require repackaging through your liver
- Digestion because amino acids are used to make digestive enzymes that break down your food
- Enzyme production (in general) because enzymes that make all of the life-sustaining biochemical reactions happen are entirely built from amino acids
- Immune activity since immunoglobulins in the gut (those secretory IgA’s I mentioned before) help to protect you from unwanted organisms + endotoxins
Another point that’s important is that amino acids are not interchangeable. Swapping them out because of low levels can cause whatever the end product is (ie. enzyme) to not work well or as efficiently.
To be clear – specific amino acids are required to make these different things throughout your body.
This is why getting an ample supply of the full spectrum of amino acids is important – but also underscores the importance of getting essential amino acids (which your body can only get access to from diet).
Protein intake at a minimum should be between 70 to 80 grams per day, and would be higher for those who are more active.
Final Thoughts On Psoriasis Nutrient Deficiencies
Nutrient deficiencies are not always apparent and are commonly blown off by conventional doctors because they don’t believe that people can become deficient as well as not having the training to understand what constitutes an insufficiency since they receive maybe a day or two of nutrition training during their entire time in medical school.
So to say that they are vastly uneducated in assessing nutrient needs is an unfortunate truth at this point in time. I say this not to knock doctors down, but instead to share a reality that can actually undermine your efforts. Even my dad who was a surgeon admitted to me that he had no experience assessing labs + clinical presentations as I did for nutrient issues + nutritional biochemistry.
I frequently see very insufficient levels of nutrients (that aren’t yet low) or that the wrong labs get run leading the doctor to assume the nutrient status is fine when the lab they chose shows a transitory nutrient status that shifts with intake rather than a marker that looks at ACTUAL nutrient stores.
So that’s why working with a nutrition professional can be really helpful because “normal” levels on your labs might not be anywhere near OPTIMAL.
Since we’re talking about labs, I mentioned earlier in this episode that labs can be incredibly helpful in determining the intake of nutrients beyond a review of your diet (we do both in my practice).
Here are the labs that I commonly use in my practice to help assess what’s going on:
- Blood labs
- Functional stool test (NOT Viome)
And if you’re looking for help with this – we’re happy to help since we work virtually with clients all over the world.
I hope this episode piques your interest to look beyond your diet for my listeners living with psoriasis. Diet is certainly a component, but true need and absorption of nutrition is a factor that you have no way of assessing just by diet alone.
Given the stress that your system is under because of psoriasis, it underscores why identifying nutrient deficiencies as one of the hidden sixteen root causes I discuss is so important!
If you’re wondering how you can get started, my Skin Rash Root Cause Finder Guide actually has an entire assessment on nutrient deficiencies so you can at least get an idea of this area as well as other potential issues lurking under the surface.
If you’ve got any questions or thoughts to share about this, leave a comment below so I can address them.
And then share this episode with someone you know living with psoriasis who NEEDS to hear this info to support them on their journey.
Thank you so much for tuning in and I look forward to seeing you in the next episode!
REFERENCES
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432353/
- https://onlinelibrary.wiley.com/doi/full/10.1111/dth.15685
- https://lpi.oregonstate.edu/mic/other-nutrients/essential-fatty-acids#food-sources
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846864/
- https://bmccomplementmedtherapies.biomedcentral.com/articles/10.1186/s12906-019-2777-0
- https://www.sciencedirect.com/science/article/pii/S2772613422000014
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6879356/
- https://www.ncbi.nlm.nih.gov/books/NBK441923/
- https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5806803/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046644/
- https://www.sciencedirect.com/science/article/abs/pii/S0946672X20301139?via%3Dihub
- https://link.springer.com/article/10.1007/s12011-012-9479-5
- https://lpi.oregonstate.edu/mic/minerals/selenium#:~:text=The%20richest%20food%20sources%20of,seafood%2C%20followed%20by%20muscle%20meats.
