Hello everyone! Welcome back to another Friday blog. Today I wanted to look at Psoriasis and its complications. We often think of it as just “itchy skin”, but it’s much more sinister. It is actually an autoimmune response that can affect not only your skin, but your joints and other areas of the body. So, what is psoriasis?

“Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by raised areas of abnormal skin…The five main types of psoriasis are plaque, guttate, inverse, pustular, and erythrodermic.  Plaque psoriasis, also known as psoriasis vulgaris, makes up about 90% of cases.  It typically presents as red patches with white scales on top.  Areas of the body most commonly affected are the back of the forearms, shins, navel area, and scalp.”

Normal skin turnover rate is 28-40 days. With psoriasis, there is an increased turnover rate to 3-4 days! This is very significant and leaves you with red, dry, itchy and irritated patches. It is worse in winter, with NSAIDs and beta blockers (blood pressure med) and can spread over large areas of the body. Interestingly, “psoriasis shares striking similarities with atherosclerosis, such as the histological features and a immunoinflammatory cascade involving Th1 (helper T-cell), Th17 (helper T-cell), Tregs (regulatory T-cell), and downstream expression of cytokines.” 

It is considered an IMID (immune-mediated inflammatory disease).  So, what causes psoriasis? There is a genetic component, but also environmental. It can be triggered by a viral or bacterial infection, as well as antibiotics. This can change your microbiota in your gut, leaving you with the “bad bugs” in charge. This causes damage to the ‘tight junctions’ in the wall of the intestine, allowing the bad guys to travel out and into other areas of the body wreaking havoc. Your body responds to try to ‘kill’ the bad guys. The altered microbiota stimulates the helper T cells (Th1,Th17), releasing cytokines, interleukins and other inflammatory molecules, while suppressing the T regulatory cells. A study found increased numbers of Enterrococcus Bacteroids and Clostridium Citroniae in psoriatic patients, while decreased numbers of Akkermansia Muciniphila.  So, increase in “bad” and decrease in “good” microbes. When they supplemented the good microbes in mice, it reversed the damage to their colon. Wow!! 

They also found the numbers of good microbes were low in all chronic diseases such as IBD, Chrons, obesity and psoriasis, while numbers of bad were significantly high! This is really key to understanding what is happening in the body. This reduces the ability to perform major function of the good microbes, which is to produce vitamins and enhance absorption of micronutrients and vitamins. To make matters worse, many medications used to treat, like corticosteroids, literally worsen the situation. “Treatments include steroid creams, vitamin D₃ cream, ultraviolet light, and immunosuppressive drugs, such as methotrexate.” Since vitamin D is synthesized in our skin in response to sunlight, and psoriasis is a widespread skin condition, it is only logical that psoriatic patients need to supplement vitamin D3. Low levels of vitamins D3, allow the bad microbes to penetrate the intestinal lining and leak out. This causes a ‘leaky gut’ and autoimmune issues. As psoriasis worsens over time, it can become psoriatic arthritis.

“Psoriatic arthritis is a form of chronic inflammatory arthritis that has a highly variable clinical presentation and frequently occurs in association with skin and nail psoriasis. It typically involves painful inflammation of the joints and surrounding connective tissue, and can occur in any joint, but most commonly affects the joints of the fingers and toes. This can result in a sausage-shaped swelling of the fingers and toes known as dactylitis.  Psoriatic arthritis can also affect the hips, knees, spine (spondylitis), and sacroiliac joint(sacroiliitis).  About 30% of individuals with psoriasis will develop psoriatic arthritis. Skin manifestations of psoriasis tend to occur before arthritic manifestations in about 75% of cases.” One study found a delay in diagnosis of merely 6 months led to joint erosion and worsening long-term outcomes.

So, what can we do to halt and reverse this terrible condition?  **consult your MD before starting a supplement regimen**

• Vitamin D - this is actually a fat-soluble  prohormone that acts like a natural prednisone. It directly inhibits Th1 and Th17 while stimulating the regulatory T cell. It is “involved in bone metabolism, calcium absorption, skeletal mineralization, calcium, and phosphorous homeostasis and has numerous physiological and metabolic functions. Vitamin D deficiency is now a worldwide problem and recognized as a pandemic affecting global health.” Biological functions also include “multiplication and differentiation of keratinocytes, maintaining the cycle of hair follicles, and suppressing tumors, due to suppressing TNF-α (tumor necrosis factor-α) . Studies have established that Vitamin D also exhibits photoprotective, anti-inflammatory and wound healing effects.” natural sources of vitamin D include: cod liver oil, cheese, egg yolks, mackerel, salmon, tuna fish, and beef liver. You may need to supplement as much as 40,000 IUs/day due to damage to the colon.
• Omega 3s - cod liver oil - anti-inflammatory and healing to the lining of the colon. Studies show supplementation decreases skin reddening, itching and scaling.
• Probiotics - replenish the good microbes!!! These microbes are needed for absorption of zinc and other trace minerals.
• Prebiotic - dietary fiber is the food for the good microbes
• Bile salts - stimulates vitamin D receptor, enhancing binding of vitamin D, aids in breakdown of food, since the good bacteria aren’t there to help. (TUDCA 3-4/day) - take on empty stomach
• CoQ10 - stabilizes cell membranes and mitochondrial membranes! Found in all membranes throughout the body! Completely blocked by statin drugs
• NO GLUTEN!!! - inflammatory to gut and liver
• NO SUGAR!!!  - feeds bad microbes. Decreases absorption of nutrients, contributes to insulin resistance
• AVOID PROCESSED FOODS - Typically contains preservatives, stabilizers, additives, and conditioners that wreak havoc on our bodies and kill our good microbes. Contributes to leaky gut, allowing bad microbes to escape through tight junctions in the intestinal wall.
• EAT ORGANIC - pesticides kill our good microbes, allowing the bad to take over! Glyphosate binds to your trace minerals (zinc). Leads to IBD, Chrons, psoriasis and other issues. In 2007 they used 80,000 metric tons in our environment. Avoid GMO (genetically modified to withstand glyphosate)!
• Zinc - trace mineral deficient in soil. Estimated 2 billion people are deficient. Your body can’t store it! It is a cofactor for >300 enzymes and participates in >1,000 interactions in the body. 10% of protein in our bodies are bound to zinc. Very involved in skin issues, depression and insulin production. Foods high: Oysters, Beef, Crab, Pumpkin seeds. Consider supplementing if you aren’t eating these foods. Natural anti-inflammatory and antioxidant.
• IF - intermittent fasting - this works AMAZINGLY well to get your entire body back on track due to AUTOPHAGY!! Autophagy: (auto “self” phage “eat”) This is a clean up and recycle process the body does to take care of misfolded or mutant proteins, bacteria, viruses and other molecules in order to maintain cellular homeostasis. It takes about 16 hours without food intake just to initiate it. The longer time you can go before eating your next meal (up to around 72 hours), the better the results. When looking at mice, researchers determined that a 1:3 ratio is OPTIMAL for longevity. Drink lemon-water and take supplements to reset your body and your immune system. Guess what? EVOO stimulates autophagy!!! Check out blog #41!

• Eat fermented foods: they naturally increase the good microbes!! Organic apple cider vinegar (with the mother),  plain Greek yogurt, sauerkraut, kimchi, kefir, kombucha. Sauerkraut is super high in vitamin C!!
• Turmeric - powerful anti-inflammatory, healing, calming.
• Take cool showers, heat and sweat aggravate the itchy skin
• Exercise - important for all health issues to improve circulation, digestion and many other metabolic processes!!
• Hydrate - drink more water. Your skin protects from water loss, but is dysfunctional with psoriasis, so you lose more water!!!
• Selenium - trace mineral. “Selenium can influence immune response by changing the expression of cytokines and their receptors or by making immune cells more resistant to oxidative stress. It was reported that selenium supplementation had inhibitory effects on TNF-α (tumor necrosis factor-α) in patients with psoriasis. Selenium compounds are also known to prevent the in vitro release of UVB-induced proinflammatory cytokines by inhibition of mRNA in human keratinocytes.” This slows skin cell turnover.
• B12 - insufficiency increases the inflammatory pathway with cytokine production and hyperhomocysteinemia (HHcy). “Recent studies have demonstrated that patients with psoriasis have a significantly higher serum homocysteine (Hcy) level and a higher prevalence of hyperhomocysteinaemia (HHcy). Insufficiency of folic acid and vitamin B₁₂ can be a cause of HHcy in psoriasis. Hcy may promote the immuno-inflammatory process in the pathogenesis of psoriasis by activating Th1 and Th17 cells and neutrophils, while suppressing regulatory T cells.” So, it inhibits the autoimmune-response!!

• Sleep -  According to a 2018 report in the medical journal, Reumatologia, poor sleep quality was found in 67.7% of the PsA patients and 57.7% of people with psoriasis. The researchers further note sleeping disorders in people with PsA (psoriatic arthritis) and psoriasis are related to poor quality of life and severe fatigue. Also, “the main symptoms of psoriatic disease, including dry, itchy skin and joint pain, might be keeping you up at night. Additionally, psoriatic disease is also associated with two common sleep disorders: sleep apnea and restless leg syndrome.” Your body heals itself when we sleep, so enhancing sleep can be very beneficial! If you snore heavily, you may have sleep apnea, so get tested. Check out Blog # 30 on sleep!

• EVOO - Rich in polyphenols that are selectively antimicrobial!  Enhances good microbes, while destroying bad. Protects the lining of the intestine to prevent leaky gut! Polyphenols are antioxidant and anti-inflammatory. EVOO is one of the most powerful functional foods! EVOO has been described as a “key bioactive food because of its high nutritional quality and its particular composition of fatty acids, vitamins and polyphenols. Indeed, the beneficial effects of EVOO have been linked to its fatty acid composition, which is very rich in monounsaturated fatty acids (MUFA).”  The polyphenols in EVOO naturally protect the plant  from viruses, bacteria and oxidation. It does the same thing for our bodies!!  EVOO has 200 times the amount of vit E and 80 times the amount of vitamin K when compared to virgin coconut oil. EVOO acts dually as a supplier and cofactor of B-carotene (converted to vit A in small intestine), increasing the absorption and bioavailability of carotenoids over that of eating fruits and vegetables! EVOO also increases levels of peptide YY and enteroglucagon (controlling glucose levels). Transport proteins in the brush border membrane are highly expressed in diets rich in fats. EVOO literally can help heal our intestinal lining, restoring normalization to the intestinal wall. Olive constituents possess antimicrobial, anticancer, antidiabetic, antioxidant, antihypertensive, antiinflammatory, and antinociceptive properties and contribute to cardioprotective, gastroprotective, and neuroprotective activities. “Studies indicate that EVOO and its polyphenols can improve diseases symptoms in IMID (immune-mediated inflammatory disease) by acting both at local and systemic levels and by modulating several molecular pathways.” EVOO stimulates autophagy as well! 

Okay, so this is a lot to digest! Haha. No pun intended. Are you guys seeing an overwhelming theme here? Our gut health affects everything in our bodies!!! You fix that, you’ve gone a long way to protecting your overall mortality and quality of life.

So, until next time my friends, drink, drizzle, digest high polyphenol EVOO, eat wild-caught fatty fish rich in Omega 3s, eat organic, get plenty of sunshine and supplement vitamin D, get your trace minerals, eat foods high in lutein, drink lots of water, get a good pre/probiotic, exercise your body and mind, add a few minutes of mindful meditation to your day to combat stress, get plenty of sleep and...turn off the light!!  #EVOO