A Root Cause Medicine Protocol for Patients With Psoriasis: Comprehensive Lab Testing, Therapeutic Diet, and Supplements

Psoriasis affects more than 8 million Americans and 125 million people worldwide. The effects of this dermatologic appearance extend deeper than the cosmetic appearance of the skin: 60% of individuals with psoriasis report their disease harms their quality of life. Individuals with psoriasis also experience higher rates of cardiovascular disease and depression. Yet, there is no known cure for psoriasis. (24) 

Functional medicine helps mediate psoriasis's negative toll on affected individuals by addressing the underlying factors contributing to this complex autoimmune skin disorder. This article delves into functional medicine as an innovative avenue for psoriasis treatment, spotlighting its personalized strategies to alleviate symptoms, decipher the root causes, and foster lasting wellness. 

[signup]

What is Psoriasis?

Psoriasis is a chronic autoimmune skin disorder that causes cells to build up rapidly on the skin's surface. This accumulation of skin cells leads to thick, silvery scales and red, inflamed patches that can be itchy, painful, and sometimes even bleed. Psoriasis is not contagious and varies in severity from person to person.

Normally, skin cells go through a cycle of growth and shedding over the course of about a month. In psoriasis, this process is greatly accelerated, with new skin cells being produced in a matter of a few days rather than weeks. These excess cells then accumulate on the surface of the skin, leading to the characteristic symptoms of the condition. Psoriasis can affect any part of the body, including the scalp, elbows, knees, and nails. (1) 

Types of Psoriasis

Plaque psoriasis is the most common form of psoriasis, affecting about 80% of those with psoriasis. It is characterized by raised, inflamed, itchy, painful red skin patches with silvery-white scales. Plaques often appear on the scalp, knees, elbows, belly button, and lower back. (19) 

Inverse psoriasis affects 25% of people with psoriasis. It develops in skin folds, such as the underarms, under breasts, and buttocks. It looks inflamed and raw, appearing as deep-red or darkened smooth skin. (11, 19)  

Guttate psoriasis affects roughly 8% of people with psoriasis and is characterized by small, round discolored spots on the arms, legs, and torso. (19) 

Pustular psoriasis accounts for about 3% of psoriasis cases. White pus-filled pustules surrounded by inflamed skin may appear on certain body parts, such as the hands and feet, or cover most of the body. (19) 

Erythrodermic psoriasis is the rarest and potentially life-threatening form of psoriasis. This type of psoriasis causes intense skin discoloration, making it look burned, and shedding of skin layers in large sheets. Other symptoms during a flare may include severe itching and pain, rapid heart rate, fever, dehydration, and nail changes. (19) 

Psoriasis Signs & Symptoms

The signs and symptoms of psoriasis will vary depending on the type a person is affected with. The most common symptoms include: 

• A patchy rash that ranges in appearance from spots of dandruff-like scaling to eruptions over the majority of the body
• Rashes varying in color from shades of purple to pink with gray or silver scales
• Small scaling spots
• Dry, cracked skin that tends to bleed easily
• Itching, burning, or soreness of the skin
• Cyclic rashes that flare for weeks to months before subsiding

Psoriasis can also affect the nails. When it does, psoriasis will cause pitting, abnormal nail growth, and discoloration of fingernails and toenails. Psoriatic nails might separate from the nail bed or even crumble. (23) 

Additionally, patients with psoriasis are at a higher risk for other health conditions, including (11): 

• Psoriatic arthritis
• Inflammatory bowel disease (IBD)
• Anxiety and depression
• Uveitis (inflammation of the eye)
• Cardiovascular and metabolic conditions, including insulin resistance, elevated cholesterol,  atherosclerosis, heart disease, and non-alcoholic fatty liver disease (NAFLD)

Psoriasis Possible Causes 

The cause of psoriasis isn't fully understood. It's considered an immune system problem where infection-fighting cells, called T cells, infiltrate the skin, mistakenly attack healthy skin cells, and stimulate the proliferation of keratinocytes, the predominant skin cell type found in the outer layer of skin. This dysregulation in keratinocyte turnover results in the formation of thick plaques. In addition, epidermal skin cells fail to secrete lipids, resulting in flaky and scaly skin. (21) 

Researchers believe that both genetics and environmental factors play a role in triggering this immune dysregulation. If you have a family history of psoriasis, you are at higher risk of developing the condition. HLA-Cw6 is a specific genetic marker most strongly associated with psoriasis susceptibility. Other common triggers for psoriasis include infections, cold and dry weather, injury to the skin, smoking and heavy alcohol consumption, and rapid withdrawal of corticosteroids. (21, 23)

Emerging research underscores a robust link between the gut and psoriasis, underscoring the gut's potential to shape the disease's onset and severity. The gut houses a diverse array of microorganisms called the gut microbiota, with studies revealing that individuals with psoriasis may display variations in their gut microbiota composition compared to those unaffected by the condition. Some of these gut bacteria could impact immune responses and inflammation, thereby influencing the development of psoriasis. Moreover, certain studies propose a potential connection between individuals with psoriasis and increased intestinal permeability, or "leaky gut," which could permit harmful substances to enter the bloodstream, inciting immune reactions and contributing to systemic inflammation, potentially exacerbating psoriasis symptoms. Furthermore, the gut is a pivotal center of immune system activity, where immune cells interface with the gut microbiota, actively orchestrating immune responses. This gut-immune system interplay is intertwined, with imbalances in gut microbiota or disturbances in the gut's immune regulation potentially triggering the activation of immune cells implicated in psoriasis development. (11)

Diet is also emerging as a significant influencer, capable of impacting gut health and consequently influencing psoriasis. Dietary components, including processed foods, high sugar and alcohol consumption, and inadequate intake of nutrient-rich foods, are believed to affect gut microbiota composition and inflammation, influencing psoriasis symptoms. The role of food sensitivities in the development of psoriasis is an area of ongoing research. Most of the available data indicate a high incidence of celiac disease and gluten intolerance in patients with psoriasis.

Functional Medicine Labs to Test for Root Cause of Psoriasis

Functional medicine testing offers a variety of specialty labs that help in identifying the root causes of psoriasis so that effective treatments can be individualized to patients.

Inflammation

Chronic inflammation is a hallmark of psoriasis, contributing to the increased production of skin cells and the formation of plaques. Inflammation can also affect other body parts, leading to conditions like psoriatic arthritis. Measuring inflammatory markers like CRP and ESR can identify and quantify the presence of inflammation at the time of diagnosis. Additionally, these markers prove beneficial to track over time to monitor patient progress and treatment efficacy. 

Comprehensive Stool Analysis

A comprehensive stool analysis can detect dysbiotic patterns within the intestinal microbiota, evaluate markers of immune function, and quantify inflammation, short-chain fatty acids, and bile acids - all important factors related to the progression and severity of psoriasis. 

Intestinal Permeability Screen

Using a blood sample, the Array 2 panel by Cyrex Laboratories differentiates between transcellular and paracellular intestinal permeability, epithelial barrier dysfunction in the form of actomyosin antibodies, and immune reactivity to lipopolysaccharides. This test detects leaky gut and explains the underlying mechanism disrupting intestinal integrity.

Adverse Food Reactions

Various food testing options exist to screen for dietary triggers related to psoriatic disease. IgA and IgG antibodies are two types of immunoglobulins produced by the immune system. Their presence, assessed with a food sensitivity panel, indicates adverse food reactions that can influence gut and skin health. Given the prevalence of gluten intolerance in patients with psoriasis, a comprehensive panel that screens for celiac disease and non-celiac gluten sensitivity should also be considered.  

Stress Hormones

Stress can exacerbate leaky gut, contribute to skin inflammation, and impair skin barrier function. These effects culminate in irritated skin and worsening skin conditions, including psoriasis. Salivary cortisol testing evaluates the circadian secretion of cortisol, the master stress hormone, identifying dysfunctional stress response patterns.

[signup]

Conventional Treatment for Psoriasis

Various treatments are available to manage psoriasis, including topical creams, light therapy, oral medications, and biologic injections. Treatment choice depends on the severity of the condition and individual patient factors. (21) 

Functional Medicine Treatment Protocol for Psoriasis

A functional medicine approach to treating psoriasis involves a holistic and personalized approach that addresses the underlying factors contributing to the condition rather than just focusing on symptom management. Functional medicine practitioners seek to identify and address the root causes of psoriasis by considering factors such as genetics, environment, lifestyle, diet, gut health, and immune system function and using complementary and integrative modalities like nutrition, lifestyle modifications, and nutraceuticals. 

Therapeutic Diet and Nutrition Considerations for Psoriasis

An anti-inflammatory, healthy diet supports healthy skin and reduces risk factors for heart disease. The Mediterranean diet has shown positive impacts on psoriasis and cardiovascular health. This diet involves eating whole foods that have anti-inflammatory properties, are nutrient-dense, and are rich in healthy fats. Studies have supported a dose-response relationship between adherence to the Mediterranean diet and improving psoriatic symptoms.

Experimentation with elimination diets can also be considered. Because food sensitivities vary between individuals, customizing an elimination diet based on suspected or lab-identified food sensitivities is recommended. It is generally advised to eliminate food triggers for 6-8 weeks before reintroducing foods back into the diet. During each phase of this elimination-rechallenge plan, patients should pay close attention to changes in their psoriasis symptoms to determine whether a food is triggering their skin.

Supplements Protocol for Psoriasis

Supplemental protocols should be customized based on patient lab results and preferences and should always be recommended secondary to foundational lifestyle modifications. Many evidence-based topical and oral micronutrients, probiotics, and botanicals can be prescribed for treating psoriasis and optimizing skin health. Below is a sample protocol for psoriasis that can be used as a template in clinical practice.

Vitamin D

Vitamin D deficiency is an independent risk factor for psoriasis; vitamin D levels have been measured to be seven times lower in patients with psoriasis compared to healthy controls. In addition to regular exposure to sunlight, serum vitamin D levels can be optimized with dietary supplementation. Large-scale studies are needed to more definitively determine the efficacy, optimal dosing, and adverse effects of oral vitamin D administration in patients with psoriasis. However, the small published studies report improvements in psoriatic lesions with vitamin D supplementation.

Dose and Duration will vary depending on serum vitamin D levels. 2,000 IU of vitamin D daily is a typical maintenance dose; however, higher doses will be required to correct vitamin D deficiency and obtain optimal serum levels. High-dose vitamin D supplementation should performed under the guidance and monitoring of a healthcare professional. 

Curcumin

Turmeric and its powerful constituent, curcumin, have been studied for their anti-inflammatory and antioxidant properties. Research has identified that turmeric can alter inflammatory cytokine expression, clinically translating to reduced psoriasis flares. Two systematic reviews have found that turmeric supplementation in both topical and oral forms is effective in alleviating psoriasis symptoms (20, 27). 

Dose: 500-1,000 mg up to four times daily

Duration: three months

Bile Acid Factors®

Bile acids aid in healthy digestion, supporting gut health and function. Additionally, emerging research suggests they also have therapeutic effects in treating psoriasis through their immunomodulatory effects and influencing the differentiation of keratinocytes (12, 25)

Dose: 1 capsule taken with every meal 

Duration: three months

Probiotics

Dysbiosis of the skin microbiome is associated with psoriasis; psoriatic lesions have a higher abundance of Streptococcus, reductions in Propionibacterium, and a general lack of microbial diversity (30). Oral and topical probiotics can rebalance the gut and skin microbiome to manage psoriasis. A systematic review concluded that treatment with oral probiotics (Lactobacillus and Bifidobacteria species) improves psoriasis area and severity index (PASI) scores.

Dose: 10-20 billion CFU daily 

Duration: 8-12 weeks

When to Retest Labs

While some patients may observe improvements in psoriasis as soon as one month after starting a psoriasis treatment protocol, it may take up to three months to begin to see improvements in skin health. Functional medicine labs that assess gut health and hormonal balances are typically ordered in 3-6 month intervals to assess functional changes induced by a treatment protocol accurately.

Learning More About Psoriasis

• Magazine Article: Top Labs To Run Bi-Annually On Your Psoriasis Patients
• Case Study: How Kristin Radically Improved Her Psoriasis With An Elimination Diet And Supplements
• Podcast: Revolutionizing Autoimmune Care Through Diet and Lifestyle with Dr. Terry Wahls

[signup]

Summary

By addressing the intricate interplay of genetics, lifestyle, environment, and immune responses, functional medicine empowers patients and practitioners to embark on a journey toward uncovering the underlying drivers of psoriasis. Through its individualized strategies that embrace the power of nutrition, gut health, stress reduction, and immune modulation, functional medicine offers a more holistic and sustainable approach to psoriasis management - one that seeks to enhance skin health and restore the intricate equilibrium of the body.