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217: Health Concerns Linked to Psoriasis (You SHOULD Know About)

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Did you know that psoriasis is associated with a bunch of other health issues?

Things like hypothyroidism, metabolic syndrome, diabetes, PCOS, Non-alcoholic Fatty Liver disease, and liver fibrosis, just to name a few.

Many of my clients have no idea about these connections and have unfortunately had their concerns about other health issues blown off.

Because there is so much newer research coming about about these issues, I wanted to share some of the research that I’ve seen so that you can ask better questions and know what you should be on the lookout for.

Because psoriasis can impact so so so much more than just your skin (as if that isn’t bad enough on its own).

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In this episode:

  • Health conditions often associated with psoriasis that should be on your radar
  • Blood sugar + metabolic health concerns
  • Thyroid problems — is this a big deal?
  • Why you absolutely CANNOT overlook or ignore your liver
  • Diabetic medication (or an herb I often use in practice) that can be helpful for psoriasis

Quotes:

A fascinating 2019 study found that out of the 400 patients with severe chronic plaque psoriasis, 53% were insulin resistant⁠ while 22% had type 2 diabetes⁠.

Out of 215 patients with moderate to severe psoriasis in a 2021 study, 42.3% had some degree of Non-alcoholic Fatty Liver disease (NAFLD).

 

Doctor in hospital hall

Health Concerns Linked to Psoriasis (You SHOULD Know About) (FULL TRANSCRIPT)

Welcome back to episode #217 of the Healthy Skin Show!

In today’s episode, I want to alert the listeners who are struggling with psoriasis. So if you’ve gotten this diagnosis, you must be aware that there are other health concerns that you may be more susceptible to.

Unfortunately, these health issues are commonly ignored or overlooked.

Some clients and community members have been told by their doctor that there is nothing you can do so why worry about it.

But frankly if you’re here listening to this show, I imagine that you DO care about these issues and WOULD want to know if they’re going on.

AND like me, you probably would want to know what you could do to support your body better so that it doesn’t simply stay on this downward slide.

I personally find it rather troubling that the attitude exists in certain corners of conventional medicine that you do nothing until you’re sick enough.

Only then you’ll get meds to “manage” the problem.

In my personal opinion (which was honestly shaped by my father who was a medical doctor and surgeon), that’s incredibly reactive and presents problems that you might never have had to face if only attention was paid to crucial factors while possibly helpful interventions were employed sooner.

Since I’m sure you’d rather not deal with another problem on top of psoriasis, let’s talk about other health issues you need to watch out for!

 

Woman having her thyroid checked by a doctor

Thyroid + Psoriasis Issues

The first issue associated with psoriasis that I’ve talked about before is thyroid problems.

This came on my radar when a psoriasis client ran the full labs that I recommend only to discover that her TSH was insanely high at 33 (for context, optimal TSH is between 1 and 2)!!!

I immediately referred her to an endocrinologist who got her on medication to help normalize her levels which vastly improved a number of her complaints.

My client actually shared her journey in episode 148 to help raise awareness about this issue because of how profoundly this one piece of her journey was for her.

Until that point, no one ever checked her thyroid.

I’m not sure why her symptoms which were alarming at that point were continuously blown off, but action was taken once she had the test results in hand to prove that her issues were something more serious.

Research points towards an increase in Hashimoto’s and other thyroid issues when you’re diagnosed with psoriasis which I discussed at length in episode 101 of the Healthy Skin Show.

If you’ve not had your thyroid checked or it isn’t checked annually with your blood labs, I highly recommend that you request that your provider begin including at least TSH annually especially if you find that your symptoms are similar to those of low thyroid function including:(1,2,3)

  • Fatigue
  • Weight gain (or trouble losing weight)
  • Feeling cold / Difficulty regulating your body temperature to stay warm
  • Dry skin / dry rashes
  • Thinning hair / hair loss
  • Constipation
  • Depression
  • Muscle weakness
  • Low libido
  • Elevated cholesterol labs
  • Puffiness in your face
  • Swelling in the lower part of the front of your throat where your thyroid is

This list isn’t a complete list, but sharing a list of these issues when you ask for your doctor to test your thyroid is helpful for them to know.

A full thyroid panel to request includes TSH, Free T4, Free T3, reverse T3, TPO antibodies and Thyroglobulin antibodies.

And while TSH isn’t the best marker to understand the full picture of thyroid health, it may be the only thing your doctor will run unfortunately.

If that’s the case, you can always run a full thyroid panel yourself through certain third-party lab testing websites with pre-negotiated rates to keep tabs on things yourself.

 

Healthy and Unhealthy food

Metabolic Health Problems Linked To Psoriasis

Metabolic issues seem to go hand-in-hand with psoriasis which underscores the necessity even more to focus on blood sugar control. Weight gain and obesity also tends to have a negative impact on disease severity.

To illustrate the connection between psoriasis and blood sugar control, a fascinating 2019 study found that out of the 400 patients with severe chronic plaque psoriasis, 53% were insulin resistant while 22% had type 2 diabetes.(4)

The association between diabetes and psoriasis is well known with some as recent as 2020 questioning if they are somehow more interconnected than simply just comorbidities for each other. That possibly there are genetic and other factors that we have yet to consider tying them together.(5)

One recent paper suggested including Metformin (a common diabetic drug) for psoriasis treatment plans. The authors noted that “combination therapy with metformin and methotrexate has also been shown to be more effective in treating psoriatic arthritis than methotrexate alone.”(6)

And that “from the perspective of quality of life, combined therapy with metformin and methotrexate significantly improves the quality of life of patients with psoriasis compared with therapy with methotrexate alone.”(6)

I’m not necessarily advocating for you to take more medication, but this is interesting enough that I felt it worthwhile to bring to your attention.

Because berberine (which is a botanical similar in nature to Metformin) shows promise in altering the cytokine-inflammatory issue associated with psoriasis as well as helping to support blood sugar levels.(7) It’s one reason I use it in my practice with clients where it is appropriate (please talk with your practitioner before adding this into your regimen as it can negatively interact with diabetic medication or make issues worse for those with low blood sugar).

And since we’re talking about metabolic health, I wanted to also mention the link found in a large 2020 retrospective population-based cohort study showing that those with PCOS (polycystic ovary syndrome) have a higher risk of developing psoriasis. The risk was higher for those under 20 years old, but even higher for those over the age of 50.(8)

In terms of testing, a fasted glucose test isn’t sufficient as the only blood sugar marker.

My recommendation would be to ask your doctor to include the Hemoglobin A1c (HbA1c) marker which provides an average of blood sugar for the past 3-4 months in addition to a fasted comprehensive metabolic panel.

The fasted insulin marker might also be of benefit as would monitoring your own glucose levels with either an at-home blood glucose finger stick test or a continuous glucose monitor.

 

Milk thistle

Liver Problems that You Can’t Ignore (If You’ve Got Psoriasis)

And the last area that I’d like to highlight for you today would be the connection between psoriasis and liver issues.

More specifically, I’m talking about Non-Alcoholic Fatty Liver Disease (NAFLD) and fibrosis of the liver.

If we jump back a moment to the 2019 study with 400 participants who had severe chronic plaque psoriasis, researchers found that 50% of the psoriasis participants had NAFLD.(4)

And 14.1% also had advanced liver fibrosis.(4)

I’ve also personally seen enough labs from psoriasis clients at this point to see the common trend of elevated liver enzymes on their fasted comprehensive metabolic panel.

Often it’s blown off until the liver enzymes are quite high and only then is the additional liver test known as GGT run and possibly a liver ultrasound.

This is a shame because the prevalence of liver issues is likely higher than most realize!

A recent report published in April 2021 demonstrated that out of 215 patients with moderate to severe psoriasis, 42.3% had some degree of NAFLD ranging from mild to severe status. Those with psoriasis and NAFLD tended towards a more severe disease presentation along with “significantly higher levels of TNF-α, transforming growth factor-beta (TGF-β), and IL-23 than those without NAFLD.”(9)

There’s also some papers connecting the dots between psoriasis, NAFLD and issues associated with the gut, but that’s a lengthy topic for another podcast episode. For now, you could check out episode 69 and episode 91.

It’s my hope that sharing this information will empower you to get better care and also become proactive (if you currently don’t have these issues) to keep an eye on them and even make changes now that could have positive ramifications down the road.

If you’ve got any questions or thoughts to share about this, leave a comment below so I can address them.

If you’re in a FB group or know someone who is a fellow psoriasis warrior, this is really important to pass along because it’s much too often that people find out about these issues associated with psoriasis after they’re already struggling with them. Educating those in this community gives them the opportunity to ask better questions, get appropriate testing run and hopefully avoid or deal with whatever they’re faced with sooner rather than later.

Before you head off for your day, take a moment to rate and review the Healthy Skin Show on your podcast platform. And hit the subscribe button so you can tune in each week for new research, tips, and inspiration.

Thank you so much for turning in and I look forward to seeing you in the next episode!

 

Woman in the library

REFERENCES

  1. https://www.niddk.nih.gov/health-information/endocrine-diseases/hypothyroidism
  2. https://my.clevelandclinic.org/health/diseases/12120-hypothyroidism
  3. https://www.webmd.com/women/hypothyroidism-underactive-thyroid-symptoms-causes-treatments#1-2
  4. https://jamanetwork.com/journals/jamadermatology/fullarticle/2735254
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7548229/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8065978/
  7. https://www.nature.com/articles/s41419-019-1510-8
  8. https://www.mdpi.com/2077-0383/9/6/1947/htm
  9. https://www.nature.com/articles/s41598-021-88043-8#Sec2 

A fascinating 2019 study found that out of the 400 patients with severe chronic plaque psoriasis, 53% were insulin resistant⁠ while 22% had type 2 diabetes⁠.


Jennifer Fugo, MS, CNS

Jennifer Fugo, MS, CNS is an integrative Clinical Nutritionist and the founder of Skinterrupt. She works with women who are fed up with chronic gut and skin rash issues discover the root causes and create a plan to get them back to a fuller, richer life.


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