Psoriasis is a chronic autoimmune disease affecting millions, characterized by accelerated skin cell production leading to scaling, inflammation, and discomfort. While conventional treatments focus on reducing inflammation and slowing skin cell growth, emerging research explores alternative approaches, including dietary interventions like the ketogenic diet. This article delves into the current understanding of the relationship between the ketogenic diet and psoriasis, examining the scientific evidence and potential mechanisms of action.
Understanding Psoriasis
Psoriasis manifests as thick, red patches that may bleed and crack, often appearing on elbows, knees, and joints. On darker skin tones, psoriasis may present as darker brown or purplish color patches. The affected skin can be dry, itchy, and painful. Many individuals with psoriasis also experience swollen and painful joints. The condition is characterized by flares, where symptoms worsen before subsiding.
Psoriasis is not contagious, but a family history of the condition increases susceptibility. It is also linked to other conditions like inflammatory bowel disease, depression, anxiety, and psoriatic arthritis. The exact cause of psoriasis remains unclear, but the immune system, genetics, and environmental factors are believed to play a role. Environmental triggers can include certain medications, infections, stress, and injuries.
The Ketogenic Diet: A Potential Therapeutic Avenue
The ketogenic diet, characterized by high fat, moderate protein, and very low carbohydrate intake, has garnered attention for its potential therapeutic effects on various conditions, including skin problems. While scientific evidence specifically on keto and psoriasis is still limited, existing research and anecdotal experiences suggest potential benefits.
Inflammation Reduction
Inflammation is a central feature of psoriasis. The ketogenic diet has demonstrated anti-inflammatory properties in numerous studies, reducing inflammation and improving inflammatory conditions like arthritis and dermatitis. Studies suggest that the low sugar intake and healthy fats characteristic of a ketogenic diet can decrease inflammatory markers more effectively than a low-fat diet. By eliminating sugar and refined carbohydrates, known to fuel inflammation, a well-balanced ketogenic diet may help mitigate the inflammatory processes involved in psoriasis.
Read also: Easy Low-Carb Cheese Crackers
Mitochondrial Benefits
Research indicates that the ketogenic diet may benefit the mitochondria, the powerhouses of cells, and inflammatory dermatologic diseases. Conversely, excess sugar can damage mitochondria. Studies also suggest the potential of keto for autoimmune diseases like multiple sclerosis.
Weight Management and Metabolic Improvement
Psoriasis is associated with obesity, metabolic syndrome, and dysfunctional metabolism. The ketogenic diet is known for boosting metabolism, normalizing blood sugar and insulin levels, and promoting weight loss. By promoting sustainable weight loss and stabilizing insulin levels, the ketogenic diet may indirectly improve psoriasis symptoms. Insulin resistance, which is connected to psoriasis, can be improved by lowering sugar intake and increasing healthy fat consumption.
Gut Health
The gut microbiome, the community of microorganisms residing in the digestive tract, plays a crucial role in overall health and may influence psoriasis. Studies have revealed that individuals with psoriasis often have less diverse gut bacteria compared to those without the condition. A well-formulated, whole food-based ketogenic diet may improve digestive health, especially when incorporating fermented foods and probiotics.
Elimination Diet Approach
An elimination diet, where potential trigger foods are removed and then reintroduced, can help identify individual sensitivities. Many psoriasis experts recommend trying an elimination diet, cutting out common allergens like eggs, nightshades, and gluten for a period of time. By carefully monitoring symptoms and keeping a food diary, individuals can identify foods that worsen their psoriasis.
Recent Research Findings
Recent research has shed light on the potential benefits of combining the Mediterranean diet with the ketogenic diet for individuals with psoriatic disease. A study involving 16 subjects with psoriasis and psoriatic arthritis investigated the efficacy of an 8-week Mediterranean diet followed by an 8-week ketogenic diet, or vice versa, with a 6-week washout period in between.
Read also: Keto Calorie Counting: A Detailed Guide
The study, led by Vaia Lambadiari, MD, PhD, aimed to assess the efficacy of a Mediterranean and ketogenic diet for both psoriasis and psoriatic arthritis. Participants had to have a Psoriasis Area and Severity Index (PASI) score improvement of less than 75% and moderate to severe joint activity.
Study Design and Methods
The randomized, open-label, controlled crossover trial involved dividing participants into two groups, one starting with the Mediterranean diet and the other with the ketogenic diet. After eight weeks, the groups switched diets following a six-week washout period. Researchers collected baseline data on participants' demographics, lifestyle, medical history, and dietary patterns. They also conducted physical examinations, PASI and DAPSA assessments, and blood sampling for inflammatory and hormonal markers. The main outcome measure was the change in PASI and DAPSA scores after eight weeks on each diet.
Key Results
The investigators reported that both the Mediterranean and ketogenic diets led to major reductions in participants’ BMI, weight, total fat mass, circumference of waste, and levels of visceral fat as opposed to the levels at baseline. Individuals involved who used the ketogenic diet were also shown to have substantial PASI score decreases as well as decreases in IL-6, IL-17, DAPSA, and IL-23. The research team noted that no major shifts were observed in these markers after following the Mediterranean diet compared to the point of baseline.
The study found that both the Mediterranean and ketogenic diets resulted in significant reductions in weight, BMI, waist circumference, total fat mass, and visceral fat. However, only the ketogenic diet led to significant reductions in PASI scores, Disease Activity Index of Psoriatic Arthritis (DAPSA), interleukin (IL)-6, IL-17, and IL-23 levels compared to baseline.
These findings suggest that a 22-week combination Mediterranean-Ketogenic diet program designed for individuals with psoriasis (PsO) and psoriatic arthritis (PsA) may result in benefits reflected in the indices of disease activity, according to recent findings. The ketogenic diet element of the program was the primary diet attributed to these benefits, though beneficial tendencies were also seen with the Mediterranean diet element.
Read also: Magnesium Supplements for Keto
Implications
The investigators highlighted that the impacts of such diets on psoriatic disease are still relatively unknown. These findings further establish the association between dietary interventions and auto-inflammatory disorders and emphasize the need for more, large-scale interventional trials to compare different dietary patterns.
Considerations and Potential Downsides
While the ketogenic diet shows promise for managing psoriasis, it is essential to consider potential downsides and individual responses.
Fat Composition
One animal study suggested that MCTs from coconut oil could worsen psoriasis symptoms due to the potential buildup of neutrophils in the skin. However, this study used lab animals and did not replicate a whole-food approach to keto, so it didn’t replicate an actual keto diet. Mouse studies indicated that different ketogenic diets affected skin inflammation differently, depending on the composition of the diet. Therefore, the type of fats consumed on a ketogenic diet may influence its effects on psoriasis.
Individual Variability
Responses to the ketogenic diet can vary significantly. Factors like body mass index, infections, medications, stress, and alcohol consumption can influence psoriasis. The ketogenic diet might be another factor that plays a role in psoriasis in certain subsets of patients.
Potential Nutrient Deficiencies
Strict adherence to a ketogenic diet may lead to nutrient deficiencies if not carefully planned. It is crucial to ensure adequate intake of essential vitamins and minerals through nutrient-dense foods or supplementation.
Additional Insights from Metabolomic Analysis
A metabolomic study involving 30 psoriasis patients on a ketogenic diet for 4 weeks revealed significant changes in their metabolic profiles. The study, conducted in Italy, recruited patients from hospital wards and made diagnoses based on clinical characteristics.
Study Design and Methods
The study involved a 4-week ketogenic diet intervention, with researchers collecting blood samples at baseline (T0) and after 4 weeks (T1). They analyzed various biochemical and clinical parameters, including lipid profile, azotemia, insulin, and homocysteine. Daily nutrient intake was monitored, and dietary supplements were discouraged.
Key Findings
The study found that the ketogenic diet led to improvements in DLQI, PASI, VAS pain, and VAS pruritus clinical scores. It also resulted in decreased concentrations of bilirubin, cortisol, LDL, and total cholesterol. Insulin and HOMA-I, returned to healthy average ranges.
Metabolic Pathways Affected
The metabolomic analysis revealed significant changes in metabolic pathways, including those related to lipid metabolism and tyrosine metabolism. These changes suggest that the ketogenic diet may influence inflammatory status and adipogenesis.