196: Psoriasis Diet + Hidden Gut Problems w/ Emma Gould

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Did you know that diet and gut problems can have an effect on psoriasis? My guest is here to share more about it!

Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

My guest today, Emma Gould, has a degree in Human Biology with Psychology and is a BANT Registered Nutritional Therapist.

Emma's own journey with psoriasis started when she was in her teens but really took hold after the birth of her first child when she was 30.

After some years of using steroid creams, she decided to change her diet and lifestyle. Five months later, her skin cleared completely! She had learnt the power of Nutrition, retrained as a Nutritionist and now uses her own experiences and knowledge to help others.

Join us as we talk about how diet can have an impact on psoriasis.

Has your psoriasis improved with dietary changes? Tell me about it in the comments!

In this episode:

• Emma's personal experience with psoriasis
• What are some of the common issues that Emma sees on stool tests that could partially drive clients' psoriasis?
• How to get your digestive system into the “right state” to help it function optimally
• Phase 2 liver detox

Quotes

“If bacteria are gram-negative, then they're giving off something called LPS inside your gut, which then crosses over the damaged cell lining of the wall of the intestines, then gets into the bloodstream. And then this is when the body doesn't recognize what these foreign objects are and starts to get over-activated, and it's this overactive immune system which can lead to psoriasis in people that are susceptible to that.” [9:25]

“We need the digestive enzymes to break down protein, basically. And there's a lot of studies where it's been shown a link between psoriasis and incomplete protein breakdown, which sometimes starts higher up with the stomach acid, so I also see lots of clients have low stomach acid.” [11:10]

Links

Find Emma online

Follow Emma on Instagram

Healing Psoriasis by Dr. John Pagano

Is Psoriasis A Gut Problem? (PODCAST)

196: Psoriasis Diet + Hidden Gut Problems w/ Emma Gould FULL TRANSCRIPT

Jennifer: Thanks, Emma, so much for being here. I'm really honored to have you on the show.

Emma: Thanks so much for having me. I'm excited.

Jennifer: I know. It's so great to finally have you on. We've been going back and forth on Instagram for quite a long time, and I'm glad that we were able to work this out because I think that, not only your story of having psoriasis, so you really know what it's like to be in the trenches and struggling with what's going on with your skin, but then you also work with people who have psoriasis, and actually, other skin conditions too.

Jennifer: So we'll talk a little bit about that, but I think what's most important, what people would really appreciate hearing first from you, is just your story, your experience with psoriasis, so can you tell us a little bit about that?

Emma: Yep, sure. So I first started to get psoriasis when I was about 16. I was doing my A Levels. It was a quite stressful time. Stress is quite a big trigger for me, and it just started just inside my ears, so the hairline there, really. To be honest, I didn't really think much of it. It was a little bit sore, kind of flaky. I used to pick it. But it wasn't ever bad enough that I went to the doctor, just dealt with it by myself.

Emma: And after probably a few months, really, after my exams had finished, it just went away by itself. And then I think it stayed away, actually, through most of my twenties. I had dandruff in my hair, so I'm never too sure now whether it was dandruff or actually scalp psoriasis back then, but just, it was never really a big problem at all.

Emma: But when I turned 30, I had my first child then, my daughter, and when she was about six weeks old, that's when it started to spread over my body. So it started first, just with two patches on my elbows, and at first, I just thought it was dry skin where I'd been leaning over the bath to give her baths. I though maybe I'd just been rubbing against the bath there. But it just wasn't disappearing, so at that point, I went to the doctor, and that's when they said it was psoriasis. And-

Jennifer: And what options did they give you with that? Did they say there was anything that you could do?

Emma: So it was straight on the steroid creams, really, at that point, which I didn't really question, to be honest. I was just given this cream by the doctor and I started to use it. And at first, it did the job. I think it went away for a bit, but never stayed away for long, started to come back. And obviously, I was having quite a stressful time, just not really sleeping, craving these carbs and sugary foods because I was so tired. And then, yeah, just over the next few years, really, just started to climb up my forearm a little bit, and then on my knees, it started as well.

Emma: And then three years after that, I got pregnant again with my second child, my son, and when I was pregnant with him… It's quite interesting, pregnancy, isn't it, because some people, it clears up, but for me, it got worse, and I didn't want to use the steroid creams at that point. So I remember, actually, I went to go and see a private dermatologist at that point, just to see, is there anything I can do without steroid creams, without medication, because I was pregnant. And he gave me some ideas, oat baths, that I did for a little while. Never mentioned nutrition or anything like that. Yeah, that wasn't mentioned at all.

Emma: And then my second child was born, and not long after, when he was a few months old, we were moving house. But the house fell through, and that's when it really just took hold of my body. And I was about 50% covered then, I think, and just, it was stress again, it was just everything all at once. And I was still using the steroid creams, but I was using so much of it and it just wasn't having any effect at all, to be honest, at that point.

Jennifer: And so, at what point… because this sounds like turning into a nightmare, almost, where you've got two very young children, you're trying to move. That, in and of itself, those are two very stressful situations by themselves, so let's mash them together. And then we've got life, in general, happening at the same time. It sounds like there was a lot going on. What was the point where you were like, “I've got to do something else”?

Emma: Mm-hmm (affirmative). So I guess, my son was about one, we'd finally moved, life had got a bit more manageable again. And so, I come from a holistic background. My grandmother was a homeopath. We were brought up quite naturally, but somehow, in my twenties, I just lost that path somehow. But I feel like it was always in the back of my mind, just the natural upbringing.

Emma: I just started to Google one day, natural methods to heal psoriasis, and stumbled across quite a famous book by Dr. Pagano called Healing Psoriasis, and found his reviews on Amazon. The reviews were just incredible. So many people saying it's helped them, and I just felt that it was the answer for me, so ordered the book, read it from cover to cover, and just decided that this was going to be what helped me and this was my answer, basically.

Emma: And that's what I did for about the next four months, so just stuck very strictly to it. For those that don't know the book, you take out… Actually, he does say to include gluten, which was quite unusual, because nowadays, that's one of the first things that you take out, but good, brown, like he says, wholemeal bread. But it didn't really feel right to me, so I cut out gluten, cut out dairy and sugar, and just really emphasized the vegetables and the fruit and the smoothies.

Emma: And yeah, ate that way for about four months, but as often happens, my skin got worse and worse, and it's… I was expecting it from the book, luckily, but it was such a hard time because you're doing everything right and I'd really believed this book was my answer, and just to see your skin getting worse, and it was just so red and angry and inflamed and itchy. It was never itchy before, but when I was healing, it became itchy. And actually, now, if I see clients, that skin itching, I always relate to the liver, the liver is struggling a little bit. So looking back, I think that's probably what was happening.

Emma: And then, all of a sudden, after about three and a half months, maybe a bit more, it's like I just suddenly turned a corner, and all the patches started to flatten and spread out, the redness went. And within about 10 days then, my skin, it kind of just swept through my body, and the whole skin just completely cleared in about 10 days. And yeah, it was completely clear after that.

Jennifer: That's amazing. And so, did it stay that way, or did you come to realize that that was just sort of one… the diet, at least, was just one piece of your puzzle?

Emma: Okay, so it stayed that way, but I wanted to know why my body had reacted that way. And I've got a degree in human biology, which I got when I was 18, so I had this knowledge of how the body worked anyway. But of course, we never really learned about nutrition in that degree, so that's when I went back to college and started studying nutritional therapy.

Emma: So I did that for three years, part-time, and it was just exactly what I wanted to learn, basically. It was how nutrients help your body to heal, but also exactly what's going on in the gut to cause that in the first place, which was… I didn't really understand, why was the psoriasis there in the first place?

Jennifer: I know that you do offer stool testing in your practice, just like I do. I'm a big fan of testing certain things because I think it gives us other clues. Like you were saying, diet is one piece of the puzzle, but why is this happening? Why am I reacting to foods? Why is my body reacting this way? At least from your experience, what are some of the common problems? When people have stool testing done, who do have psoriasis, what are some of the common issues that you see on stool tests that could partially drive their psoriasis?

Emma: Mm-hmm (affirmative). So I've had stool testing on myself as well, so I guess with my own testing, the first one that I did, I had a lot of dysbiosis, so I had an overgrowth of some gram-negative bacteria. And there was three different types that I had, Citrobacter and Enterobacter. So basically, if bacteria are gram-negative, then they're giving off something called LPS inside your gut, which then crosses over the damaged cell lining of the wall of the intestines, then gets into the bloodstream. And then this is when the body doesn't recognize what these foreign objects are and starts to get over-activated, and it's this overactive immune system which can lead to psoriasis in people that are susceptible to that.

Emma: So firstly, I had, yeah, an overgrowth of these gram-negative bacteria. I also had Candida, a yeast. I had quite low elastase, which is a measure of your digestive enzymes from the pancreas. And we know from studies that psoriasis is linked sometimes with incomplete protein breakdown, so protein starts to be broken down by the stomach acid, firstly, and then it moves down. And if it's the right pH, if the stomach acid has done its job, the food has the right pH to activate the enzymes from the pancreas, so if you're… I'm going to say that again. Okay, where did I start from?

Jennifer: Just start.

Emma: Okay, so I had quite low elastase. It was under 200, which now, if I see an elastase under 200, I refer to the GP straight away because it's a sign that your pancreas is struggling and it's not producing enough digestive enzymes. And we need the digestive enzymes to break down protein, basically. And there's a lot of studies where it's been shown a link between psoriasis and incomplete protein breakdown, which sometimes starts higher up with the stomach acid, so I also see lots of clients have low stomach acid.

Emma: Sometimes it's due to H. pylori, which I always test for. Sometimes it's due to stress, not enough co-factors, so we need zinc and B6 and some other things to make stomach acid. Basically, if the stomach acid isn't strong, then the protein isn't being broken down properly. It starts up there, and if it's not being broken down properly at the start, then by the time it gets to the pancreas, it's not the right pH to activate the pancreatic enzymes as well.

Emma: So that was something that I needed to work on. My secretory IgA, which is a measure of your mucous membranes, so your whole GI tract, from your mouth, all the way down, is coated by a layer of mucous membranes. And it's just an added layer of protection. It's kind of your first line of defense against anything that gets into the body. And we like to see it up around 150, and mine was 15, so it was just really low again, possibly linked to… I had H. pylori as well. There was just basically loads going on for my stool test.

Jennifer: Yeah, and I actually see the same. It's very common. I would say about 90% of people have low stomach acid. I'd say another 90% of people have low pancreatic enzyme output. Some have a weird combo. They might have enough stomach acid, but not enough enzymes. It's hit or miss, whether… Some people have high secretory IgA, which can be a marker for inflammation, whereas other people have low levels, like yourself, and that means it's difficult for them to mount a response because we don't have that police force available. I like to call the secretory IgA… I'm like, “It's like your police force.” It's your first line of defense, and we need those in order to be able to protect ourselves because we're coming in contact with other organisms all the time.

Jennifer: So I think it's really important for people to hear too, that you've personally gone through this and that your psoriasis wasn't just, and for those who are listening to this podcast, it's not just, “genetic,” right? A lot of times, people are told that, “Well, it's just genetic. We don't know why you get it.” Well, we actually can look deeper than just these, “Sorry, here, you have this diagnosis. That's all it is. You're just going to have to learn to live with it.” [crosstalk 00:13:58]-

Emma: And even if it is genetic, that's your susceptibility to it. They always say genes are like the loaded gun, but it's your environment that pulls the trigger. So even if it is genetic, it doesn't necessarily mean you're going to get it. It's still within your power to do something about it.

Jennifer: Exactly. I wanted to ask you… because I think you made a good point before we started recording this, that a lot of people have trouble with stress. Stress is a huge component, I would say, across the board for most chronic skin issues. But when it comes to how we eat and just food in general, there's also a lot of stress around that because sometimes people will develop fear around eating food, or they're eating in a rush, or constantly stressed.

Jennifer: But being stressed and eating, and then hopefully, digesting and absorbing that food, those things don't really go hand in hand. So can you talk a little bit about the importance of what we need to do before eating in order to get your gut, essentially, your digestive system, in the right, oh gosh, this is a weird phrase, state of mind, so to speak, in order to do what it's supposed to be doing? And by the way, everyone, these tips are all free tips. They don't cost you a dime, and they're very important to anyone who is having chronic skin issues. So Emma, what's your take on this?

Emma: So we've got the two branches of the nervous system. There's the sympathetic and the parasympathetic. And we need both of them, actually, but we need both to be in balance. But what we find nowadays is loads of people just get stuck in this sympathetic branch of the nervous system. So your sympathetic is your fight or flight. It's the kind of running from the bear, running for your life, which in the olden days, there'd be a bear, you'd run from it, the bear would go, and you'd go back to your relaxed, parasympathetic branch again.

Emma: Because so many people are just stuck just with these daily, everyday stressors, the commute, everything that's just going on in life, you're kind of stuck in this fight or flight mode. If you try to imagine trying to digest a meal whilst you're running from that bear, it's just not going to happen. Your digestive system just isn't functioning to digest a meal right now. It's kind of saving its life. So it's just really important to try, for eating, to switch to your parasympathetic, which is also known as rest and digest.

Emma: So a way that I always tell my clients to do that is to take six deep breaths before eating, so ideally, get your food on the plate, on the table, look at it, take six deep breaths and just feel yourself relaxing, and your body is just preparing to take the food in then. And it's quite interesting when you do that. I know it feels a bit of a chore to be doing that, but it's… You can feel yourself starting to salivate. And I always think, if you're salivating, then it also means that everything else is activating in your body, so you've got your digestive enzymes, your stomach acid. The whole body is just preparing to have this food and to digest it.

Emma: But also, it's just really important not to drink with meals because drinking dilutes stomach acid and digestive enzymes, so not to drink half an hour before or after each meal. Chewing is really important. I try to say around 30 chews per mouthful. Again, it just is a bit soul destroying to count to 30 with every mouthful. So just, I'd say, even just to do it once, just to remind yourself what it's like to do that.

Jennifer: Well, and the other thing that I also say to my clients is, “You don't have teeth anywhere else in your GI tract, so if you don't chew your food when you take a bite, it's not going to get chewed up anywhere else, and there's no backup system. Your stomach can't do the work. Your small intestine, your large intestine, each serves a very significant and distinct purpose, and if you essentially shortcut and rush through one area, you're going to have problems all the way down.”

Emma: Yeah, and it's our only conscious part. It's the only thing that we can do to help the whole digestive process, because as soon as you swallow, you're kind of handing it over to your body then, so I feel like it's the least we can do. Just help your body out a bit and just chew. And it's quite interesting if you're not used to doing that because it gets really liquid in your mouth, which, I don't know, when I first started to do it, I wasn't used to that. I was used to swallowing whole particles of food, which is where problems can arise.

Jennifer: Absolutely. And so, you know one of my favorite topics is the phase two liver detox. I talk about that a lot and it's a very important conversation that I tend to have with potential new clients. I talk a lot about it on Instagram. I don't even know how many times I've mentioned it in podcasts.

Jennifer: But I think you made an interesting point before we started recording about the importance of phase two detox for psoriasis, so I'd love for you to share your experience around why… If you're listening to this and you're struggling with any type of psoriasis, so don't get caught up in the weeds, oh, I have plaque psoriasis versus guttate psoriasis, whatever, just psoriasis. If you have that diagnosis, this is an important thing for you to hear.

Emma: Mm-hmm (affirmative). So the liver detox pathway, there's two phases, maybe three, depending how you look at it. So phase one makes things more toxic. I always think it's quite interesting, because milk thistle actually increases phase one, so if you're… So this is something that you can learn if you have your genetic testing done, how fast, genetically, your phase pathway is working. So personally, I've got quite a fast phase one, but a slow phase two, so what it means is, if I have something like milk thistle-

Jennifer: Or caffeine. Or caffeine-

Emma: Yeah, I'm-

Jennifer: … will speed it up too, yeah.

Emma: … really sensitive… Yeah, I'm really sensitive to caffeine, and actually, also, things like ibuprofen, pharmaceutical drugs like that.

Emma: So at the end of phase one, the substance you've took is actually more toxic. And then phase two is conjugating, so adding something to it to make it less toxic, to get it out of the body. But yeah, for phase two, we need B vitamins for that to work, magnesium, enough protein, so it's really important to get enough protein. I always say minimum of 0.8 grams of protein per kilogram of body weight.

Jennifer: Ooh, say that again. I want to write that down, and we're going to put it in the show notes. What is your recommendation?

Emma: So minimum of 0.8 grams of protein per kilogram of body weight. And again, sometimes it might be worth just tracking for a few days on one of the online trackers, just to see how much protein you're getting. If you're doing any form of exercise, particularly weight resistance, you need to almost double that sometimes.

Emma: And yeah, we were speaking earlier about people who sometimes have been on really restricted diets and just aren't getting the protein, aren't getting the B vitamins and the magnesium. And it just means that your liver detox pathways aren't open, which is the very thing that you need because your liver is helping your body to get rid of the toxins, whatever toxins are in the body. And it could be coming from foreign bodies being in your gut, it could be from food you're eating. But either way, we need the liver to be good and strong, so it's, yeah, really important to be getting enough of those B vitamins, magnesium, zinc, especially, as well, and protein.

Jennifer: Yeah, and the protein thing too, I think the other point to also make, and we were talking about this before too, is that protein intake is incredibly important. However, if your digestive system is compromised in some way, so if you have IBD or you have celiac disease, you might not be able to absorb as much from your food. And if you are having trouble breaking protein down because there's not enough stomach acid, just because you ate it doesn't mean your body gets access to it, so it has to be absorbed.

Jennifer: So we want to keep that in mind, and that may be where a hydrolyzed protein supplement for a period of time to get the levels boosted back up can be helpful. I know people sometimes cringe because they're like, “That sounds super processed.” I'm like, “Well, let me tell you, when you don't have enough protein and you really start adding it in, you will notice. You start to feel quite significantly better within a matter of three to four weeks,” so it can make a big difference.

Jennifer: And so, before we wrap up, I just wanted to ask, do you have any maybe words of advice for somebody who's really struggling right now? When you had your psoriasis explode and you're in this really dark place of… You can't control it, you feel like your body is just not working with you here, not getting with the program. Do you have any words of advice for people who are in that spot where they don't know what to do and they're trying to figure it out, maybe they're still just doing the dermatologist's recommendations, or maybe they've started to veer into changing their diet, but they're just really struggling?

Emma: Yeah. I think it's so easy to turn against your body, and just to kind of see yourself as separate from your body, and see these awful marks on your body and start to almost despise yourself for it. I think it's so important just to connect the body as a whole, and to love yourself all the more, really, and to see that you're not separate from your skin, you kind of, you are your skin, and to… We're so lucky now, actually, with all the online resources out there. There's an amazing psoriasis community out there, so maybe do some research.

Emma: And just, there's so many ways to empower yourself to make the changes yourself. And I know that sometimes we get told that, “You've got psoriasis, it's forever, kind of deal with it, take this and take that,” but there are other ways to deal with it, which… And I always think, what harm does it do if you're… Even if you do eat a bit healthier, do some exercise, find ways to manage with stress, you're only going to feel better in yourself. It's not going to do any harm, so why not give it a go?

Emma: So yeah, really to maybe research online resources, come and speak to me, and I can help you dig deep if you want to get to the real root cause of what's going on in your gut, which just really helps with motivation as well, and just to see something written down in black and white, because there's also just a lot of guesswork about with all the different diets and different things you can do. You're just, “Oh, maybe I'll try this,” or you hear one supplement is good, you think, “Oh, I'll try that supplement for a while.” Test, don't guess, just have it done, and just kind of bite the bullet and have a tailored protocol going forward which you know is actually going to work for you.

Jennifer: Yeah, having a plan is so important, and it also is just helpful to have direction. Direction is critical. And so, I know you mentioned about the diet and everything like that. You've got a great e-book on your website, the Seven Psoriasis Friendly Recipes. So if people go over to your website, nutritionbyemma.co.uk, they can download a free copy of that e-book and take a look at what your philosophy is around diet changes that may be helpful, and then also to find a lot of resources that you have on your website.

Jennifer: And I just want to encourage people to, especially if you have psoriasis, you can follow Emma over on Instagram. I don't remember exactly how we connected, but that's how we got to know one another, was on Instagram. And her handle is [_nutraskin_ 00:26:39], and we'll put all of the links to her website, her Instagram, and her Facebook page on the show… or in the show notes. That way, you guys are able to easily find her and connect with her. She's so, so wonderful.

Jennifer: And especially if you're in the UK and you're looking for help, it's nice to have a resource who can get you the right testing, give you direction, also help you get professional grade supplements and things, because it can be a challenge to do on your own. Just like in the US, there's a lot of restrictions and things like that, so it's nice to have a guide to help you with that. But Emma, I just want to thank you so much for being a guest on the show. It's been so great having you, and hopefully, we'll have you come back some time.

Emma: Thank you so much. It's been great.