069: Is Psoriasis A Gut Problem?

I’ve long found that psoriasis clients have connections to gut and liver issues even if they have absolutely no symptoms.

Because I’ve mentioned before that there are 16 root causes of chronic skin rash conditions like psoriasis, what I’m about to share with you pretty mind-blowing!

I stumbled across a paper in a major dermatology journal that details some really incredible information that in many respects flies in the face of how we currently address psoriasis.

The question that I’m left with is… why isn’t this making its way down to the doctor’s office?

If you’ve only been told that psoriasis is a skin problem, get ready to have that notion completely flipped on its head!

 

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In this episode:

• Ground-breaking paper discussion by Dr. P. Haines Ely published in 2018
• Many connections between psoriasis and gut problems
• Why poor protein breakdown (from your diet) could be a major factor
• Gut infections commonly found in psoriasis
• Hidden trigger for itchy psoriatic lesions
• Ties between Non-Alcoholic Fatty Liver Disease and Psoriasis

Quotes:

Polyamines are byproducts of protein purification. Their high levels present in psoriatic skin means that you aren’t properly breaking down and absorbing dietary protein and ultimately allows your microbiome to ferment them. And then we’re shockingly seeing these polyamines out in the skin of those with psoriasis.

If you’ve ever wondered — is psoriasis caused by a leaky gut? The answer is YES. He then goes on to state that “Recent data confirms the presence of gut-derived bacterial DNA in psoriatic blood. The species identified included Escherichia coli and Klebsiella pneumoniae…”

Is Psoriasis A Gut Problem (FULL TRANSCRIPT)

Welcome to Episode #69 of the Healthy Skin Show!

In today’s episode, I want to share with you a paper that I came across titled “Is Psoriasis A Bowel Disease?” by Dr. P. Haines Ely that was published in Clinics in Dermatology in 2018.

To be fair, I’ve repeatedly tried getting in touch with Dr. Ely to have him on the show without any response. So if you know him, please connect us!

I’m a huge fan of his work and would love to talk to him further so that we can spread the word about what he’s doing to help those with psoriasis.

When I read the abstract for this paper, my jaw hit the floor!

And once I finally got my hands on the complete paper, I was like… “people NEED to hear about this!”

It really changes the way that you think about hidden driving factors of psoriasis. These are rarely discussed in dermatologist appointments and really should be.

But I also get that dermatologists aren’t trained to understand what’s going on in other systems.

I often talk about the connection between what’s going on at the level of the skin and your gut.

So that made this paper and its clinical insight so much more fascinating! ESPECIALLY because Dr. Ely has experienced such tremendous results that he discusses in his paper.

I figured that I’d pull a few brief selections from the paper and then share my clinical experience and thoughts. It’s my hope that you will find this both exciting and enlightening especially since we haven’t yet covered much about psoriasis on the Healthy Skin Show.

What Causes Psoriasis: Hidden Root Causes No One Talks About

The first part of this article discusses the connections between what causes psoriasis from a completely gut-focused perspective.

First of all, in the paper Dr. Ely explicitly states that “psoriatics have been shown to have increased gut permeability.” (source)

So if you’ve ever wondered — is psoriasis caused by a leaky gut?

The answer is YES.

He then goes on to state that “Recent data confirms the presence of gut-derived bacterial DNA in psoriatic blood. The species identified included Escherichia coli, Klebsiella pneumoniae, Enterococcus faecalis, Proteus Mirabilis, Streptococcus pyogenes, and Shigella fresneli.” (source)

So what does this mean?

We talk a lot about that connection between what's happening in the gut. As you know, with chronic skin rash conditions, there is typically an increase in gut permeability (aka. leaky gut).

Normally, bacterial species of your microbiome should be contained to your gut (aka. Colon or large intestine). However, bacterial DNA is ending up in your bloodstream.

The only way that likely can happen is that a leaky gut barrier allows those bacterial parts or the DNA to sneak into your body.

How Poor Protein Breakdown Plays A Role In Driving Psoriasis

I always say that you aren’t what you eat… but you are what you absorb.

Well, if you don’t absorb your nutrients, it’s highly likely that something else will.

And that’s not always a good thing especially when it comes to proteins in the diet.

Another point made by Dr. Ely is that “polyamines, such as putrescine, spermine, cadaverine, and spermidine, being intimately associated with cellular growth and division, are elevated in psoriatic skin. All dermatologic contributions on polyamines assumed that they were synthesized in the skin, and it was never mentioned that these are bacterial byproducts found in the gut. The exact mechanism of transport to the skin is poorly understood, but within an hour 50% of orally ingested polyamines from food are present in the systemic circulation.” (source)

Polyamines, such as putrescine, spermine, cadaverine, and spermidine. So what those basically are are byproducts of protein purification.

If you recall, I talked a lot about why you need more protein if you have skin rashes. And I also shared why the process of protein digestion and absorption is critical.

Proteins should be absorbed in the small intestine. If they aren’t, they end up in your large intestine where your microbiome will end up fermenting them. And now we know that somehow those putrified products are ending up in your skin!

Putrification is as awful and toxic as it sounds. Though we're not really sure how they're getting from the gut into the skin, we could assume that they are sneaking in because of leaky gut.

This underscores why you have to look within your gut and see what the heck is going on!

Psoriasis, Gut Dysbiosis & Infections

One of the main focuses here is your microbiome.

When you’ve got leaky gut and loads of inflammation, you still have to look towards your microbiome.

What lives there?

Is it in a healthy balance?

Are there unwanted or unfriendly gut bugs hanging out there?

The reason you must look in the gut according to Dr. Ely’s paper is that, “patients with psoriatic arthritis [have] decreased bacterial diversity in a pattern resembling the dysbiosis of inflammatory bowel disease.” (source)

That statement is mindblowing. 

As an integrative clinical nutritionist, I also found a significantly higher abundance of E.coli in clients diagnosed with psoriasis.

Another gem from this paper “revealed marked small intestinal bacterial overgrowth (SIBO) in 78.5% of psoriatics.” (source)

I’ve discussed the connection between SIBO and skin rash conditions before on the Healthy Skin Show.

And certain infections could potentially be correlated with itchiness!

For example, “H.pylori–positive patients had intense itching of their psoriatic plaques and Helicobacter-negative patients did not. Among psoriatics, 40% were Helicobacter positive, and in controls only 5% were positive. 12% of psoriatics were found to be carriers of blastocystosis. These patients were found to have the most severe psoriasis and many of them had psoriatic arthritis.” (source)

In my clinical experience, it is fairly common to see a mixed bag of gut dysfunction and gut dysbiosis…  and even gut infections.

Does that mean that you have to have gut symptoms in order to have these things going on?

No, gut symptoms aren’t a prerequisite.

I have seen clients who have had a number of infections and yet they didn't have any gut symptoms at all.

The issues entirely presented as disturbances on their skin. 

Another point that I have to make is that correcting the issues discussed won’t be solved by diet tweaks or necessarily following a psoriasis diet.

This explains why changing your diet might get you so far, but never fully resolve your psoriasis.

You get stuck in a cycle based on the various factors discussed here.

How Liver Function Is Involved In Driving Psoriasis

Another overlooked issue I commonly see in psoriasis clients is liver dysfunction.

Sometimes liver enzymes will be very high on a client’s Comprehensive Metabolic Panel (CMP) as well as their GGT.

This is something that Dr. Ely also discusses — the correlation between the psoriatic lesions and your liver function.

He says, “nonalcoholic fatty liver disease is present in 48 to 59% of psoriatics.” (source)

Wow, right?

Proper liver function is critical to ensuring that your body can do everything that it needs to. It goes well beyond just detoxifying toxins you encounter.

This doesn’t mean that you need to do a liver detox!

Healthy liver function is more complicated than that and is often tied to nutrient stores available to it (as well as what you’re eating in your diet).

The first step would be to get labs run to identify disturbances in liver function.

If you haven’t had recent labs, you could ask your doctor about getting a full lipid panel and comprehensive metabolic panel (CMP).

If you have elevated liver enzymes, another helpful test is the GGT to speak with your doctor about.

For a full list of conventional testing that I use in my practice, CLICK HERE.

If you also want to look at a more comprehensive list of functional labs that can be helpful, CLICK HERE.

It critical to get these labs done while fasted. Get your blood draw done first thing in the morning without eating or drinking anything (water only) for eight hours.

It’s equally important that you do not exercised before going to get your blood drawn. Doing so will disturb your metabolic systems.

To better understand how your liver works, this is a really simple, but clear explanation!

6 Steps You Can Take To Balance Your Psoriasis-Gut Connection

As you can see, there is a combination of gut and liver issues going on here that play a big in driving psoriasis.

Yes, it’s definitely worthwhile to clean up your diet. But diet alone may not get you to remission or make it difficult to deviate from the psoriasis diet without consequence.

#1 – Clean Up Your Diet (If You Haven’t Done So Yet)

This means no more processed foods, fast foods, refined sugars and starches. Remove gluten.

#2 – Identify Gut Function Issues

Optimizing digestion and absorption is critical!

And just because you don’t have gut symptoms doesn’t mean that you don’t have an issue.

Chewing your food appropriately is important as is having enough stomach acid (I talk about that here and how to figure that out).

For the record, having heartburn does not definitely mean that you have high stomach acid. It’s a symptom of both high and low stomach acid. Unfortunately, most people with heartburn actually have low stomach acid.

#3 – Consider Using A Full-Spectrum Digestive Aide

It may be a good idea to start on a full-spectrum digestive aid so that everything you eat at meals is digested. This maximizes your chances that it will be absorbed (rather than heading further downstream to feed gut bugs).

It should include Betaine HCl, bile acids and enzymes. (This is what I use in my practice.)

For the record, digestive enzymes alone do not make up for betaine HCl and bile. They each play an important, yet separate role.

Products like this generally should be taken about 5 or so minutes before eating every single meal (not snacks). That way, they are there for when food comes down into the GI tract.

#4 – Hydrolyzed Protein Powder To Increase Protein

The beauty of hydrolyzed protein powder is that it’s already broken down. This way, you don’t need optimal levels of stomach acid to do the work for you.

This way, the proteins are absorbed in the small intestine and do not reach your microbiome causing that putrification that I mentioned already.

#5 – Support Liver Detox Pathways

I’ve talked about this at length HERE. Supporting liver detox pathways is way more helpful than doing a liver detox or liver cleanse.

I always caution against these types of detoxes or cleanses because I’ve unfortunately seen too many people’s rashes get worse.

Detox pathways must have the appropriate nutrients available to them in order to process toxins and do what it needs to.

#6 – Quercitin Could Help

Dr. Ely mentions adding Quercitin to your regimen to help reduce histamine exposure.

Testing To Figure Out Your Psoriasis-Gut Problems

If you’re serious about diving deeper than food so you know what the heck is actually going on, testing can be really helpful.

Functional urine and/or stool tests meant to identify dysbiosis and potential infections mean you aren’t guessing about what your body needs nutrient-wise, nor what’s off about your microbiome and digestion.

I realize that there are a few labs that allow you (the consumer) to order your own stool test. But before you pull the trigger on that, keep on reading!

Stool tests that are very inexpensive and marketed to consumers have no capacity to identify these issues I’ve discussed about gut dysfunction and gut infections.

So ultimately you end up wasting money on something that is like a cute Polaroid of your gut. But nothing more.

Despite what the companies lead you to believe, there's nothing actionable you can get from these tests. They aren’t allowed to give you that sort of data.

So you end up wasting money on something that could have been put toward a test that will give you more complete and actionable answers.

I’ve worked with too many clients who were promised that these tests could tell them what was wrong. None of the steps taken helped (and for some, it made their symptoms and flares worse).

Please… if you take the next step and invest in this sort of testing, get the RIGHT test(s). These are typically only available through practitioners because there is a lot of schooling and training that goes into understanding them.

So what are some of the best tests? 

Aside from these conventional labs (which are equally important to having along with the functional ones, I use stool and urine testing from 3 different private labs in my clinical practice.

Functional urine tests could be either from great plains labs or Genova.

They are organic acid panels which help us identify nutrient insufficiencies along with certain gut dysbiosis markers. You can also look at mitochondrial function, neurotransmitter balance, methylation, free radical damage to cell walls and DNA, liver detoxification pathways, and more!

Organic Acid testing should ALWAYS be coupled with blood labs because together they give you a more complete picture of what’s going on.

As for stool testing, you have the GI Map and GI Effects test kits. Which you choose depends on what your practitioner is comfortable with.

And one final point, if you have a history of yeast infections or you've had a really long history of birth control pill or antibiotic use, you definitely need to investigate fungal overgrowth.

Unfortunately, stool tests are not a great way of picking up on fungal organisms and often give a false negative. Urine tests are the more accurate test because it looks for the waste products of fungus like candida.

Although this was a lot of information, I was just picking out pieces from this lengthy paper. Let’s keep our fingers crossed that somebody knows Dr. Ely (or he hears this podcast) and he gets in touch with us because I would love to have him on the show.

I hope that you found this conversation really eye-opening! This type of research needs to get out there and it’s simply not being shared in your dermatologist's office.

So if you have any questions about the paper or even my experience working with psoriatic clients, leave a comment below so we can continue the conversation.

And of course, make sure to share this with someone you know who's really frustrated with their psoriasis. Especially if they feel like there should be more options, but they can't seem to find any.

Now we can say for sure that there are other stones to look under to find answers that could be driving your psoriasis.

Thank you so much for tuning in and I'll see you in the next episode!