Modifying Paleo to Treat Psoriasis

April 19, 2012 in Categories: , , by

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In the paleo community, we are accustomed to assuming that a standard paleo diet will cure (or at least significantly improve) virtually every health problem.  But, if you have psoriasis (or dermatitis or eczema), be prepared:  paleo not only may fail to resolve these skin conditions, it might even make it worse.  Now, don’t go running for the hills.  The principles behind the paleo diet are still sound.  It is still the best way to eat for your long-term health.  And there are certainly some people who find complete resolution of their psoriasis symptoms with the switch to a paleo diet (for those people, the root cause of the psoriasis is typically a gluten sensitivity).  For me (and for many others), switching to paleo made my psoriasis worse.  This isn’t because paleo has us on the wrong track; it’s simply because out-of-the-box paleo is not actually enough.

I am a long term sufferer of lichen planus, a form of psoriasis where the inflammation occurs in the mucosal layer of the skin (and very unnerving, you can actually get lesions in the gut mucosa as well!).  In fact, it was my search for a cause (and hopefully cure) for this condition that brought me to paleo in the first place!  All my other health issues either completely resolved or improved substantially within weeks of switching to a paleo diet, but my lichen planus did not improve.  If anything, it got worse.  But since paleo was working so well for me in every other respect, my search for a solution stayed within a paleo framework.

What you might not know (and certainly I didn’t) was that psoriasis (and dermatitis and eczema) is an autoimmune disease.  It’s not always listed in those lists of autoimmune diseases that can be put into full remission by a paleo diet (it is listed in The Paleo Answer, but not The Paleo Diet nor The Paleo Solution).  Why is it so often left out?  I guess it’s because when compared to Lupus, Multiple Sclerosis or Non-Hodgkin’s lymphoma, psoriasis is small potatoes.  And let’s just take a moment to appreciate how lucky we are that, when our bodies formed antibodies against our own cells, we only ended up with psoriasis!

Psoriasis is also an indicator of a severely leaky gut (that’s how we develop the autoimmunity in the first place), with a very high likelihood of Small Intestinal Bacterial Overgrowth.  It is also very commonly linked to a gut-brain connection problem with inflammation and autoimmunity targeting skin cells.  I went into some details about the gut-brain connection in this post, but I also recommend listening to the explanation of the gut-brain-skin axis that Chris Kresser gives in his Revolution Health Radio podcast episode titled “Naturally Get Rid Of Acne By Fixing Your Gut”.  There is a complex interplay between a leaky gut, a stressed body, loss of insulin and leptin sensitivity, mood issues, food sensitivities, and the inflammation that manifests as psoriasis.  Basically, if you suffer psoriasis, chances are your gut, your immune system and your hormones are all really messed up.

So, what do you do about psoriasis?  The first and most important step is to follow the paleo diet “autoimmunity protocol”.  This means that in addition to all of the foods we already avoid while eating paleo, we must also avoid:

  • Eggs (especially the whites)
  • Nuts and Seeds (or at least severely restrict quantities)
  • Nightshades (tomatoes, eggplant, peppers of all kinds)

We are also people who Can Not CheatEver.  We can not tolerate any dairy, not even grass-fed butter or ghee.  Food quality becomes extremely important, so the more we can eat grass-fed meat, wild-caught fish, pastured eggs and chicken, and organic vegetables, the better (I know it’s expensive and I certainly can’t afford this 100%, but I just do the best I can).  And we are people who can’t tolerate very much sugar (even the sugars in fruits) or starches (even from superfoods like sweet potatoes) as they tend to feed the organisms in Small Intestinal Bacterial Overgrowth.  It would be worthwhile to have a look at the GAPS diet food list as an indicator of which fruits and vegetables should be avoided (although I wouldn’t suggest starting with the GAPS diet protocol unless you really have tried everything else).  And that’s not all.  Because stress hormones can play a key role in the perpetuation of psoriasis, it is especially important for us to get lots and lots of high quality sleep, avoid excessive caffeine intake (or cut it out completely), severely limit alcohol consumption (or avoid it completely), get lots of low-strain exercise, manage the stress in our lives, get sun exposure and take a Vitamin D3 supplement (on the higher dose side; I take 12,000IU per day in addition to trying to get outside every day).  I also suggest reading my recommendations on Repairing The Gut.  In particular, I suggest incorporating organ meat into your diet at least twice per week, consuming bone broth or other collagen-rich foods (like gelatin, stew hens and heart meat) at least twice per week (every day would be even better), consuming fermented foods (like raw Sauerkraut or coconut milk kefir) every day, and consuming coconut oil every day (I like it in my coffee).

So how long until you see some results?  You should start to see improvement very quickly, within a couple of days for some people up to 3-4 weeks for others.  If you do not see improvement within a month, you may also have developed additional food sensitivities (your gut is leaky, after all).  If doing all of the above still isn’t enough to see improvement in your symptoms, it would be worth finding a physician, naturopathic doctor, or chiropractor who will order an IgG and IgA food sensitivity blood test (you might also investigate Small Intestinal Bacterial Overgrowth, internal yeast infections and parasite infections as possible confounding factors as well).  These food sensitivities are transient and once your gut has healed (and at least 6 months have passed without exposure), you should be able to reintroduce the foods.  Actually, you should be able to reintroduce eggs, nuts and seeds, higher sugar fruits and vegetables and maybe even nightshades at some point in the future as well.  Are you wondering how long this is going to take?  I’m afraid the answer is anywhere between 2 months and 2 years, depending on exactly what the root causes are for you.  But, if you could see how much my lichen planus has improved in 3½ months, you would be amazed.  I know that the extra dietary restrictions are tough, but it is worth it to be able to cure such an aggravating condition without the use of steroids.  And the thing to keep in mind is that once the psoriasis is gone, out-of-the-box paleo really will be enough for us.



It’s quite hard to know what actually inflames it, but right now I’m thinking it’s whatever I’ve eaten right before I start itching, as apart from some fabric irritations, it’s quite mild and doesn’t cause me too many problems, apart from the fact it looks awful! I have realised coconut affects me badly, with bloating and stomach ache, and have also cut out dairy, coffee, alcohol, sugar and eggs, for now, to try and clear it up. I’ve upped my carbs with plantain and up to 20g of fructose a day, and think I may be seeing some improvement. I’ve read that as it starts to heal the bigger lesions start to break up into smaller ones, which I think is happening, although I may just be getting new ones I suppose! I will stick it out for a few months, but if I have had no improvement I may have to go full AIP. I am also going to try using coconut oil directly on it, starting with the first lesion which appeared, and see how that goes. I’m already cooking almost solely with it. We’ll see!!

Great article. I have psoriasis and have had great success with a very low carb diet. However, I get famished and grumpy :) and can’t stay on it for long. I am learning about fats and trying now to include them in my diet. They seem to help tremendously. Can I ask you to share good sources of fat that I can start eating. I have found that avocados work great but not quite sure how many I can have given the O6.

Any help in this area would be great. Thanks

How do you know that “we are people who can/can’t…?” Is this from your own personal experience or do you have a lot of experience treating people with psoriasis? I know that everyone has different triggers and that AIP deals with the most common ones, but how do you suggest that people with psoriasis can’t handle much sugar from fruit or starchy vegetables or any dairy? I am trying to do AIP, but hearing that I can’t even eat a sweet potato is just too much.

Love your book, just found your web site and blog and am about to embark on the paleo to help autoimmune disease. Your article relates to psoriasis which I have in minimal areas but does it also relate to psoriatic arthritis? I have been diagnosed with psoriatic arthritis 12-18 months ago and although the nsaids and dmards help a small amount I’m sure they are doing more harm than good. My rheumatologist is about to start me on Humira but obviously I would rather find a more acceptable form of treating the disease. Here’s hoping.

If it helps, I was diagnosed with psoriatic arthritis about 4 years ago (I had mild psoriasis for years before that). After doctors failed to give me any hope I found a book by Dr. John Pagano for healing Psoriasis which outlines a diet very similar to the one described in this blog (I discovered the PaleoMom website today whilst searching for a lamb stew recipe that would suit my diet), and started following it.
I wasn’t strictly 100%, but I did eliminate all nightshades and most of the other no-nos for most of the time.
Result was that after 2 years the Psoriatic arthritis had gone completely, and I am now back to running and playing volleyball like the doctors said I would never do. The psoriasis still remains a bit (although less than before), but I have relaxed the strictness of my diet (for example I now have a cup of coffee per day) and am getting a good feeling for what still keeps me in the health zone and what is too much for me (for example a one-week business trip in India eating everything I was served caused some joint pain to return. It went away again a few days after returning to my normal lifestyle).

So I am not scientific evidence (the Doctors didn’t want to see me again after I stopped taking their medication), but I think it is worth trying out. You definitely have nothing to lose by going on the dietary recommendations presented here.
Good luck!

Thanks, that helps me a lot! I was diagnosed with psoriatic arthritis 5 months ago and have been following AIP for 2 months strictly (I couldn’t manage to cut out wine just before Christmas, but was otherwise compliant before that). It’s good to know that this worked for you, as I still have constant pain but categorically do not want to take what the rheumatologist is offering me. I’ll stick with the diet for now, and keep working on the sleep/exercise/stress stuff…

Are all skin conditions, at the end of the day, caused by gut dysbiosis? That is, if one’s skin is anything but clear, are those blemishes an indicator of intestinal permeability? By extension, can all skin problems be resolved by restoring the integrity of the intestinal lining? I am speaking with keratosis pilaris in mind.

Thank`s for sharing. I also suffer from Psoriasis. I might be a sensitive to nuts, too. But can you explain why nuts and seets are harmful for people with P. ?

Perhaps I’m confused, but you listed eggs as something to avoid, and then proceeded to list them as a food to eat (pastured)…can anyone clarify?

Hi Sarah,
I am trying to heal my two year old’s bad eczema by doing the AIP and following the additional suggestions in this post. He is still nursing though, and I’m wondering if this could be holding back his healing, due to the lactose in my milk (I am on the same diet as him, so it’s not any allergic proteins in the milk)? Any insight would be greatly appreciated. Thank you in advance. Your blog has been such a wonderful source of information and help to us. :)

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