Those of us who suffer from psoriasis will do almost anything to control it, because it’s so miserable.

I’ve had severe psoriasis all my life, and have been on pretty much every medical treatment there is (some with deleterious effects!). About ten years ago, I started doing research into the connection between diet and autoimmune diseases, such as psoriasis. What’s shocking is that the medical community generally only offers treatments for the external disease. They don’t focus on whole-body health or nutrition. In over five decades of visiting countless doctors, not one has ever told me that there’s a connection to what I put in my mouth and how my skin behaves.

Not one.

Dr. David Phillips says that most medical school programs offer a paltry 20 hours of nutrition education, which amounts to only 1% of everything they have to learn. It’s no wonder they don’t talk about nutrition as one of the most powerful tools in their tool bag.

When I finally connected the food I was eating to my gut health, I realized that I was making myself needlessly suffer by causing itchy, inflamed skin. Once I drastically cleaned up my diet, my skin dramatically improved.

What’s the Best Diet to Help Psoriasis?

That’s the $100,000 question.

I don’t know about other parts of the world, but in the USA, we’re obsessed with diets. We want that easy, magic, one-shot formula to getting the results we want. Unfortunately, there’s no easy answer. But let me give it a shot here.

There are so many diets out there that have varying nuances that it quickly gets confusing and overwhelming. Furthermore, your own personal philosophies about eating omnivorous, pescatarian, vegetarian or vegan diets come into play that further muddy the waters.

I’m not going to cover commercial diets that you see advertised on TV. That’s not the purpose of this article, nor am I going to talk about weight loss, which most of the commercial products hype (not nutrition).

Generally speaking, no matter which diet you choose, the farther away you can get from prepared and packaged foods, and eat foods that are whole plants and meats, the better off you’ll be. There’s no question that once things get processed and packaged, they no longer resemble the original version and have FAR less nutritional content that our body needs.

A general rule too is that the more the packaging screams “Healthy!” the less it is. Look at the packaging in the cereal aisle at the grocery story, and you’ll know what I’m saying. To me, granola, for instance, is not healthy at all. It’s a bowl full of sugar, grains and milk – I call it a food bomb which I’ll explain below. But it’s heavily marketed as a healthy way to start your day. Hm. You don’t see anything in the produce section screaming, “Healthy”! Why is that?

So how do we boil all this down to something that makes sense? I found the fairly helpful diet comparison guide from Sutter Health, but it’s still pretty confusing. They also omit the Keto (ketogenic) Diet, which I think merits discussion (although the Atkins diet is a version of it that I don’t prescribe anymore). Keto has a bad rap but done correctly, can actually be an extremely healthy diet. I’ll get into that below.

I’ve experimented with various ways and styles of eating, and I have my personal preference, because it works for me and what I like to eat. I’m going to talk about pros and cons of these diet plans, how they specifically affect inflammation and psoriasis, and you can see what works best for you and your particular lifestyle:

• Standard American Diet
• Paleo Diet
• Zone Diet
• Mediterranean Diet
• Ketogenic Diet
• Vegetarian/vegan Diet

Which Foods Should I Eat More Of and Which Should I Avoid with Psoriasis?

I’ve seen increasing evidence from the medical community that certain foods should be avoided if you have any autoimmune (AI) disease (i.e. psoriasis, psoriatic arthritis, rheumatoid arthritis, lupus, alopecia, vitiligo, etc.—there are about 80 AI diseases). Aside from genetics (we inherit the propensity for the disease from one or both parents), they all have one thing in common: an unhealthy gut.

When we don’t put the proper foods into our mouths, our intestinal microbiome—the gut—becomes unhealthy. It communicates signals directly to the brain through the vagus nerve to “send in the troops”. Those troops are called T cells or a type of immune fighting white blood cells that fight off foreign invaders such as bacteria and viruses. But instead, they go rogue and attack our bodies, like the skin in psoriasis. Since it’s attacking itself, it’s called an autoimmune disease, because “auto” means “self”.

When we eat healthy, and feed the trillions of good bacteria in our gut, the inflammation goes down and our skin heals.

Sounds crazy, doesn’t it?

Eat More of These Foods

Overall, you should try to eat more whole plants (fruits and vegetables) that haven’t been processed. Pretty much anything in the produce section is fair game with some exceptions noted below. If you eat meat, the butcher section is “fair game” (ha) with animal products, such as meat, fish, shellfish and eggs.

You also want to increase antioxidant foods to reduce inflammation. I detail this in my recent article, 7 Ways to Reduce Inflammation to Help Your Psoriasis, but in decreasing order of antioxidant load, this would include:

• Dark chocolate (yes!)
• Blueberries
• Strawberries
• Artichokes
• Raspberries
• Kale – any of the brassicas (broccoli, Brussels sprouts, cabbage, etc.)
• Red Cabbage
• Beets
• Spinach

Foods to Avoid

The “big four” as I call them, are the most inflammatory foods you can eat:

• Sugar – in any form (including in fruit)
• Nightshades (potatoes, peppers, tomatoes, eggplant and tobacco)
• Legumes (beans, soy and peanuts)
• Grains (rice, wheat, corn, oats, etc.)

Avoid these foods as much as you can or anything made with them, including spices like chili powder, red pepper flakes, etc.

In her best selling book, The Paleo Approach: Reverse Autoimmune Disease and Heal Your Body, Sarah Ballantyne, PhD, tells us to avoid those foods, as well as nuts, seeds, dairy and eggs. Some people are sensitive to nuts (I seem to be) and coffee, which is a huge trigger food for me.

But Wait, Shouldn’t I Take Supplements?

Personally, I’m not a fan of multi-vitamins. If you’re eating healthy food (whole fruits, vegetables and meats), you’re getting plenty of vitamins. Some people call multi-vitamins “expensive urine” because most of it just gets eliminated in your urine and does no good. If you’re eating vegan, you may need to supplement with a B-vitamin complex.

But there are a few supplements that I highly recommend and take myself every day. These are all detailed in the article above, so I won’t go into the gory details here, but here’s my list of must-have supplements:

• Vitamin D3: The vast majority of us are significantly deficient in this hormone because we don’t get enough sunlight to generate our own. This is critical for skin and general immune health. Talk with your doctor to get a vitamin D blood test and work with them to get it up to the upper safe range.
• Probiotics: I used to poo poo these as just marketing hype on TV. I’ve since learned that it’s critical for gut health, and I can tell a difference when I skip it for a couple days. Take a probiotic capsule like Dr. Danielle’s Spore-Based Probiotics or eat raw, fermented foods like sauerkraut. I eat sauerkraut for breakfast every morning. Yum.
• Omega Fatty Acids: According to Dr. Bill Sears, omegas are probably one of the most critical nutritional components missing from our diet. Most of the omegas available on the shelf are made from fish oil (urp). The Juice Plus+ Omega Blend is the only vegan and balanced blend that I’ve seen on the market.
• Juice Plus+: We’re supposed to eat ten fistfuls of fruits and veggies every day. No matter how healthy I eat, I can’t get that much down. With only seasonal options available, that makes it even more difficult. Juice Plus+ is 30 organic fruits and veggies condensed into capsule or chewable form, so even if I don’t eat well that day, I know I’m getting the right nutrition in my body. It’s got over 40 independent scientific studies showing the benefits from this product, which says a lot.
• Turmeric: Turmeric is an ancient herb made from the rhizome of the Curcuma longa plant, which is closely related to ginger. It’s been used for centuries in Ayurvedic and Chinese medicine to help circulation and inflammation. Dr. Danielle’s Turmeric is also mixed with black pepper, which helps the absorptive properties of the herb.

The Standard American Diet

The Standard American Diet (yes, it’s the “SAD”) was originally published by the US Department of Agriculture in 1992 as the Food Pyramid. It has a heavy emphasis on grains, then to a lesser degree, fruits, veggies, meat, dairy and very little fat. The pyramid has been updated over the years, then changed to its current version, MyPlate, in 2011 which shows basically the same proportions.

The low-fat, high-carb dietary craze was born many years ago, as the “healthy” way to eat. Remember those yummy rice cakes that tasted like you were eating Styrofoam?

My suspicion and personal opinion is that because this is driven by the USDA, there is an unnecessary emphasis on cheaply grown grains that add to your carb load (which is turned directly into body fat), and many of those grains are contaminated by glyphosate. Further, I suspect (yes, I’m a suspicious kind of guy), that the sugar industry has had their hand in skewing things in their favor too.

There’s no question that our country has gotten sicker and fatter over the last few decades with a rise in cancer, heart disease, diabetes, and a host of other preventable ailments.

The Paleo Diet

The Paloelithic or so-called “Caveman Diet” alleges that we should go back to our roots and eat the foods that cavemen ate thousands of years ago. It’s argued that Homo sapiens evolved over many thousands of years to eat whole foods that they hunted and gathered, like nuts, seasonal fruits, vegetables and meat and eschew processed foods like sugar, flours, alcohol, dairy and legumes (which didn’t exist back then of course).

Michelle Tam from Nom Nom Paleo (my absolute fave Paleo chef) has an excellent summary of what it’s like to eat Paleo. Paleo, which (to add more confusion) more or less follows the Whole30® plan, does allow some non-grain flours such as cassava or plantain flours. Whole30 doesn’t.

But overall, this is an excellent diet to follow, and Michelle Tam explains how she went from feeling unwell and overweight to bringing back health. The same goes for those of us with psoriasis, following the Paleo diet is probably the easiest plan to follow without getting too far out of our comfort zones of eating “normal” food. Just avoid the “no” list items like nightshades (which are allowed in Paleo).

The Zone Diet and Mediterranean Diet

I’ve never followed either of these diets, but I’m sort of lumping them together (purists I’m sure will scream). At a 30,000 foot level, they both promote limited proteins from meat, and emphasize a lot more plant-based consumption. That’s never a bad thing.

My problem with both of these diets is that they allow legumes and grains. Legumes have a lot of inflammatory lectins in them that can exacerbate inflammatory diseases such as psoriasis. The same goes for many of the grains, including gluten-containing grains (wheat, rye, barley, etc.) which also inflame autoimmune diseases and may contain trace amounts of glyphosate, a gut biome disruptor.

Ketogenic Diet

The keto diet is so-named because the idea is to eat a high-fat, low-carb diet, and only eat some meat. On the surface, this sounds horrible, doesn’t it? What, do you sit around eating sticks of butter?

Absolutely not.

Eating foods that are low in “net carbs”, or foods with complex carbohydrates that aren’t easily digested (like broccoli), means that those carbs won’t turn into inflammatory adipose (fat) tissue. Eat a small amount of protein of choice per day, and then include healthy fats (olive oil, avocado oil, coconut oil, ghee) and foods higher in fat (like avocado) and it sounds a lot like Paleo.

But the keto diet is ultra-low on simple carbs (no grains or legumes whatsoever, and VERY limited fruit which has sugar), plenty of veggies, and you want 2/3 of your calories to come from fat. Your brain is mostly fat, and actually prefers fat as its fuel. Simple carb fuel is less efficient for your brain, so by cutting out all the simple carbs, your brain and gut biome will live much healthier.

It’s called the ketogenic diet because when you omit simple carbs, your body naturally goes into ketosis because it burns adipose (fat) tissue and creates ketones, which can be measured by peeing on a Ketostix® reagent strip.

There are many advantages to this diet:

• It cuts out most of the inflammatory foods that will make your psoriasis worse
• It’s an excellent way to lose weight (I lost 65 pounds in six months doing it this way)
• It’s extremely healthy for your brain and gut
• Your cholesterol and triglyceride numbers will plummet

On the last point, my total cholesterol was under 120 and triglycerides were under 70 (my doctor wanted them under 400!). My blood pressure dropped to 90/60 and I never felt better. Not too bad for a middle-aged male.

My favorite app to manage this is the Carb Manager app. You can scan package bar codes and even create custom recipes (like marinades or sauces) to track everything.

The downside to this diet? It’s HARD to maintain. There are so many tempting things out there. Eating at a friend’s house when they bring out the appetizers and other goodies, then dessert after dinner, makes it tough to stay true. One day of eating “bad” takes you out of ketosis, and you have to get back on track again.

Restaurants aren’t too bad if you stick to meat and request veggie substitutes or a salad instead of fries.

Vegetarian/Vegan Diet

There’s no question that there are many benefits to eating vegetarian and vegan. The science is absolutely clear on this. My good buddy from high school, Scott, jumped in the deep end a few years ago. He LOVED smoking meats and as a chef, enjoyed food to the max. But he had migraines, was overweight, and had high blood pressure. After going vegan, he lost 90 pounds, the migraines went away, and his blood pressure plummeted.

However, I personally can’t eat what he eats. He cooks a lot of beans (lectin-rich legumes) and foods with tomatoes (nightshades). They look delish, but I can’t eat them and live with my skin. He eats a lot of grains which we’ve already discussed.

Another challenge with vegan diets is consumption of soy-based foods such as edamame and tofu as a source of protein. Soy is not only a legume, but contains a high concentration of an estrogen-like chemical called phytoestrogens. There is ongoing debate about whether this is harmful or benign, but my personal preference is to limit most soy-containing foods.

So Which Diet Is Best For Psoriasis?

As I’ve illustrated here, there’s no simple answer to this question. Avoiding inflammatory foods as much as possible and eating whole foods as much as possible will get you a long way to helping you to heal your skin. If you can afford it—or better yet, GROW it—go organic as much as you can. An excellent way to grow crazy healthy, “cleaner-than-organic” foods is to get your own aeroponic growing system, the Tower Garden. But that’s another article for another day.

To me, the Paleo Diet is probably the most ideal for those of us who eat meat. Just omit those inflammatory foods like peppers, potatoes and tomatoes. You’ll definitely see an overall improvement of your health and your skin if you stay as true to the spirit of this as you can.

I also personally prefer the stricter Keto Diet, because I don’t want to consume any sugar at all (honey, although “natural” is sugar), and I don’t eat any fruit except antioxidant-rich berries such as blueberries, strawberries and raspberries.

If you’re vegetarian or vegan, fantastic. You’re already 90% of the way there, but you’ll have to experiment with ways to get enough protein without soy and enough food and calories without grains or legumes. That may be a bit tougher.

I would love for you to tell me your experiences and opinions here too. What works for you? What doesn’t work for you?