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

If you limit carbs you must eat equivalent calories of fat in order to have your body function. You need the fats to run on so too low a fat consumption will make you feel terrible. Get enough fat from any source possible to make this work. Coconut oil, grass fed beef tallow, pastuered lard and grass fed butter are all stable oils for cooking. Good quality organic virgin olive oil on salads or anything just don’t cook it. Figure out your calorie run rate and then figure 70% of that should come from fats and 20% protein and 10% carbs. I eat full fat cheeses, organic heavy cream for sauces and coffee, fatty meats, etc to make that fat load…when you do you’ll find you automatically lose weight if you need to.

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.

Yes, the no sweet potato is a real blow..I have it for lunch most days…what can I have that will fill me up?

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…

Tengo psoriasis y tenía artritis psoriasica. Empecé con la dieta Paleo el 1 de julio de 2015 y a los 15 días abrí una botella de agua. A los 3 meses dejé la medicación. Llevo 4 meses sin medicación y muy bien.
La psoriasis aún no tengo mejoría.

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. :)

Reading your article brought tears to my eyes – you are the first person to address what I’ve been suspecting all along: I’ve stomach issues all my life, poor sleep (even after taking sleeping aids that left non-functioning the next day), suffer from depression (among others) and just recently diagnosed as pre-diabetic. You are also the first person that doesn’t preach “cure” or gimmicky options, and I truly appreciate that. I’ve not tried the autoimmune protocol yet, but I plan to delve into it, as well as dedicating to the other areas you discussed. Thank you – you’ve encouraged me more than you realize.

YES it will.

I suffer from stage 3 HS and have done multiple skin transplants but progressively getting worse and worse over the years.

I found the AIP diet about 5 month ago and I noticed improvements in the “general conditions” like fatigue in just a few days. Then as time has progressed I do experiance improvement in my boils (frequency of outbreak, healing, pain etc) for the first time ever (it has always bin up and down but now a bad day is like a decent day before).

I will eat like this for the rest of my life if needs be. This is a game changer. For real!

I’ve had mild psoriasis on my elbow for the past 15 years. I’ve used creams, sun exposure….and it came and went but never disappeared completely. In 2007 I sprained my ankle and within a year I got psoriasis on that ankle. The swelling never went down completely and a friend thought I had psoriatic arthritis….Never diagnosed. So I just dealt with it. In 2012 the paleo diet started trending. I didn’t know of any correlation it had with correcting psoriasis. I was in a competition at my gym so I decided to try it just for weight loss. It worked, but also I noticed within one week my psoriasis was completely gone, aches and pains gone, and my energy level increased . I couldn’t believe it. I was sold and continued for three months on paleo. When the competition ended I gradually went back to old eating habits but still no psoriasis. Now I’m finding it has reappeared and I’ve never been so achy. It also spread to my other elbow. I made a decision this past weekend to go back to paleo because I no longer want to suffer needlessly from psoriasis. So we’ll see. I didn’t have an issue with eggs or sweet potatoes in my diet before when it disappeared, so I’m anxious to see if I get the same results that I did in 2012. Thank you for this info….I’ll be checking it along the way.

I posted this elsewhere but I am wondering- does anyone know if this is safe for pregnant/nursing women? I am concerned with all the restrictions if the baby will be getting everything they need. I will of course ask my doctor but I don’t think they have much experience with this.

This is an old comment but it could help future mommies- I was gluten free while pregnant and started the AIP for multiple sclerosis when my daughter was born. She is my fith child and by far the healthiest. Our family is always passing around cold etc as my children are in public school but she never seems to get sick. She is now two years old and has only ever had one runny nose to speak of and one day of light fever. I am so pleased that my diet has helped keep her so healthy. And unlike my other children she loves fish and salad!

I am in the category of those with eczema and psoriasis, but also being histamine intolerant makes diet super tricky. I’m sourcing super fresh, shorter aged, pasture raised meat and still reacting if I have more than a little more than once every two day or so. I’m not tolerating broths or gelatin. Feeling so lost!

Hi I have suffered from Psoriasis on the sides & back of my head along with Psoriasis on both elbows & knee’s for the past 2 years. I have been treated by my Dermatologist /specialist with Neotigason 10mg tablets twice a day & Daivobet ointment daily over this period of time. This treatment has not worked & I am throwing out all medication & trying Paleo diet & exercise in a desperate bid to rid this terrible disease. Thanks for for everyones contribution its been so helpful
Desperate to find a cure

Is there anything we can do to get rid of the post-inflammatory hypo pigmentation after a lesion clears? Thankfully I was able to clear my paoriasis using The Myers Way (very similar to AIP), but I still have white spots on my legs 6 months later. I’ll take the white spots over the lesions, but would love to know if there’s anything I can to do get rid of them. Thank you!

From my own experience it will help with rosacea as well. I’ve had psoriasis/psoriatic arthritis for about ten years and very mild rosacea for about the same time or maybe a little longer. It’s never been diagnosed but I get the tell-tale butterfly redness around eyes and nose. Flare ups have been greatly reduced by the Paleo diet and I actually use my rosacea as an indicator of when I’ve eaten something that will worsen my psoriasis as I will get red in the face within minutes of consuming a trigger food.

I’ve been diagnosed with psoriasis since I was nine and have always had I’ve done four whole30s, one of which was AIP, regularly slept 8 hours or more, kept stress to a manageable level, lots of sunshine, lots of grass fed beef, and yet-

The only thing that has made my psoriasis virtually disappear was when I took a long vacation and had even less stress. Since then, I’ve made drastic changes in my life and now my stress is minimal. The psoriasis has been gone for 7 months too. I guess stress was my biggest trigger??

I am suffering from psoriasis for the past 7 years..I am a vegetarian.. Can u plz suggest me the veg paleo diet for psoriasis

Great article. I’ve had psoriasis for over 10 years, tried every drug, every cream. My psoriasis covers my lower legs, back of thigh, lower back, elbows and from ear to ear on my scalp. I’ve been clearing a fair amount, by doing the following… eating as clean as i can (as much as possible), losing weight has helped, i exercise at least 5x a week, recenky started tanning and red light therapy, and i use coconut oil, olive oil and A & D ointment on my skin. I did not wear shorts or skirts for years, now my legs are clear enough to show my long legs again. I will try to incorporate info from this article to hopefully improve my comdition even more. Thank you.

you mentioned how lucky we are to have psoriasis, vs MS or such. I am not lucky. My Mother lost her life because her psoriasis attacked the lining of her lungs and keep reoccurring and effected her heart and killed her. That is not lucky. If you knew anything about psoriasis you would know it at is all the organs, the skil being visible and the largest organ we see it. Psoriasis also cause a number of other issue, including pain. I think you don’t have a good enough understanding of this disease to assume that it is not that serious. Many people suffer extreme issues that are life treatening. When my Mom eventually developed psoriatic arthritis she could not sleep, walk or move with out extreme pain. As far as your eggs , peppers and such.. That does not apply to all of us. You really need to check yourself before making such remarks because you seriously don’t know very much about what others are living with.

Yes Annette, I couldn’t agree more. Psoriasis is not a simple illness and certainly can be serious, even life threatening. I don’t feel lucky to have it.

I would be interested to know what Paleo diet experts think of my observations below as I think we may be missing something obvious here, namely; Nightshade fruits and vegetables are unlikely to have ever been part of our forebears / Palaeolithic ancestor’s diets.

Nightshade foods are recent new comers to the European, African and much of the Asian diet. If your ancestors stem from these continents then they never formed part of their Paleo diet or for much of their diet for hundreds of thousands of years prior to the late C17th to C20th Centuries. As such they are alien to our diets and perhaps that is why we get reactions to them in the same way that wheat has really only been part of the Northern European diet for the last 4,000years and some people have a wheat intolerance. As background;

Potatoes first arrived in Europe from the 1560’s onwards and only became a staple from the 1700’s onwards and consumption massively increased after the industrial revolution and arrival of the railways. They arrived in Africa and Asia much later and still account for relatively little of their diet as starchy carbs come from other sources; rice, yams, pulses, sweet potatoes etc.

Tomatoes first arrived in Europe in the 1580’s and were not grown in England for example until 1590. They have only really been part of the British diet since the Victorian period and consumption has increased exponentially in the late C20th century given increased demand for Mediterranean cuisine which followed holiday travel and immigration from the post-war period onwards. Clearly however they were not part of the original Mediterranean diet and they even less part of the African or Asia diets.

Eggplant/Aubergine – this original was originally domesticated from the wild nightshade species; one in South Asia and East Asia. They only came to Europe in the mid 1500’s and in Britain and Northern Europe for example they have only been part of our diet since the late 1960’s onwards; once again in line with holiday travel to southern Europe and SE Asia and interest in the perceived ‘traditional’ cuisines in these areas. They are also not part of the original Mediterranean diet.

Anecdotally my psoriasis completely cleared up when I spent a month in Thailand and I had always assumed this was because of exposure to the sun, relaxation and swimming in the sea. However lengthy holidays in sunny Spain, Australia and Florida never saw my psoriasis disappear quite like it did in Thailand. I now think it may have disappeared because whilst I was in Thailand I didn’t eat anything with potato or tomato in it and at the time I couldn’t handle anything with chilli peppers in it and really disliked eggplant.

I am definitely going to avoid Nightshade fruits and vegetables for a while and see if they have a similar effect on my psoriasis especially as I now have suspected psoriatic arthritis in my ankle – which has been extremely painful. Psoriasis affects people of all racial and mixed racial backgrounds and I have Indian, Spanish and North African friends with it. My ancestry is English and Irish – I think my Irish family will be amused to see me avoid potatoes but to be honest they were never part of our Palaeolithic ancestors diet.

I will let you know how I get on as I’d rather address my diet and use food as a medicine than take man made pharmaceuticals. Please let me know what you think of my observations above?

I suffer from eczema for over 50 years. It covers about 70% of my body. I did the Whole30 diet for 50 days and saw some small changes, but during the diet my skin broke out badly and certain areas have not yet healed and it itchs very badly.
I would like to try the AIP diet, but I’m concerned about two things. On the protein side, if soy, legumes, dairy, seeds and eggs are off limits and I am allergic to peanuts, tree nuts, fish and shell fish. What is left for me to eat? I cannot see myself eating beef, porc and chicken three times a day. That’s just too much meat for me to digest. I tried it on the Whole30 diet and I sometimes felt like throwing up.
Also, week 2 and 3 on the Whole30 diet were very difficult for me since I was always tired and had brain fog almost constantly. I just could not concentrate. I ate a bit more fruit and starchy vegetables to give my body the sugar it needed. I think the brain needs a minimum of natural sugar to function.
How do you get by on only meat and vegetables? It seems very drastic. I am trying to eat a healthy diet and have cut out sugar, dairy, most cereals, soy and legumes.
Please help me.
Thank you!

If you’re having a hard time digesting meat to the point that it’s making you nauseous, you may benefit from some digestive support. There are a lot of amazing AIP recipes that will make it so you don’t feel like you’re just eating meat and vegetables. I recommend The Healing Kitchen for easy AIP recipes. Eating starches/fruit are great options if your body needs the extra carbohydrates! Making sure you’re sleeping enough (at least 7-9 hours or possibly more with an autoimmune condition), getting quality sleep, and managing stress is really important as well. I hope that helps. -Kiersten

Disclaimer: I’m not a doctor.

If you’re allergic to all of these things, it probably means that your gut microbes are in total disarray. No wonder you have eczema in 70% of your body, and you’re allergic to healthy food like shellfish. Your gut is what you need to heal: go for the AIP protocol, with a lot of home-made water kefir (e,g, in smoothies), veggies (don’t eat too many cruciferous ones in the beginning though, but then add them more, and especially do eat some unpasteurized kimchi and sauerkraut), home-made bone broth almost daily in veggie soups, and the rest of the foods allowed in AIP (minus the ones you’re allergic to). Get some DHA fish oil (not one that has too much EPA in it), D3, Magnesium, and K2 Mk-4. Wake up with the first sun to walk outside, your skin needs to see the sun (before the sun becomes dangerous later in the day) because we evolved with it. Sun is life.

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