Psoriasis: What Role Does Gut Health Play?

Welcome to my blog entitled ‘Psoriasis: What Role Does Gut Health Play?’.

Before we start, other blogs that you might be interested in, include:

• The Ultimate Guide To IBS
• SIBO: What Causes It
• Inflammatory Bowel disease: The What, Why, And How

Psoriasis: What Role Does Gut Health Play?

Psoriasis is a chronic, immune-mediated inflammatory disease that affects around 125 million people worldwide. Several studies concerning the gut microbiota composition and its role in disease pathogenesis recently demonstrated significant alterations among psoriatic patients. Certain parameters such as Firmicutes/Bacteroidetes ratio or Psoriasis Microbiome Index were developed in order to distinguish between psoriatic and healthy individuals. The “leaky gut syndrome” and bacterial translocation is considered by some authors as a triggering factor for the onset of the disease, as it promotes chronic systemic inflammation. The alterations were also found to resemble those in inflammatory bowel diseases, obesity and certain cardiovascular diseases. Microbiota dysbiosis, depletion in SCFAs production, increased amount of produced TMAO (4).

Psoriasis was associated with alterations in gut Firmicutes, including elevated Faecalibacterium and decreased Oscillibacter and Roseburia abundance, but no association was observed between gut microbial diversity or Firmicutes/Bacteroidetes ratios and disease status (8).

Gut Microbiome Metabolites And Psoriasis

Five metabolites, hydrogen sulfide (H2S), isovalerate, isobutyrate, hyaluronan and hemicellulose, were significantly dysregulated in the psoriatic cohort. The dysbiosis of gut microbiota, enriched pathways and dysregulated metabolites are relevant to immune and inflammatory response, apoptosis, the vascular endothelial growth factor (VEGF) signaling pathway, gut-brain axis and brain-skin axis that play important roles in the pathogenesis of psoriasis. (5)

Psoriasis And Inflammatory Bowel Disease

There is not only substantial overlap between psoriasis and IBD, but also there are differences with implication for therapy (3)

Psoriasis and inflammatory bowel disease (IBD) are immune-mediated diseases occurring in barrier organs whose main task is to protect the organism from attack. These disorders are highly prevalent especially in northern Europe where psoriasis has a prevalence of around 3-4% and IBD around 0.3%. (3)

The Gut-Brain Axis In Psoriasis

The gut-brain-skin axis has been used to explain correlations among the gut microbiota, emotional states and systemic and skin inflammation, and this axis may be associated with overlapping mechanisms between psoriasis and depression. (6)

Can The Oral Microbiome Contribute To Psoriasis?

All culture-based studies identified an increased presence of oral Candida in patients with psoriasis, whereas small variations in the oral microbiota were found in a 16S rRNA gene-based study (1).

Leaky Gut And Psoriasis

All patients showed increased levels of the enteric permeability marker zonulin which correlated with the frequency of peripheral Th17 cells. Calprotectin, a marker for intestinal inflammation was elevated in 6 out of 10 patients (9).

Gut Inflammation And Psoriasis

All patients showed increased levels of the enteric permeability marker zonulin which correlated with the frequency of peripheral Th17 cells. Calprotectin, a marker for intestinal inflammation was elevated in 6 out of 10 patients (9).

Which probiotic is best for psoriasis?

Probiotics were associated with a significant improvement in the severity of psoriasis, but did not change microbiota (1)

Probiotic intake resulted in a reduction of disease activity and gut permeability. These effects, however, were not sustained beyond termination of probiotic intake (9).

The probiotic given included fructo-oligosaccharide P6 (a prebiotic), inulin P2 (a prebiotic), vegetable protein and nine bacterial strains of Lactobacillus and Bifidobacterium with at least 7.5 billion organisms per portion (called OMNi-BiOTiC® STRESS Repair).

In another study the results of follow-up 6 months after the end of the study showed a lower risk of relapse after the intake of the probiotic mixture. Analysis of gut microbiota confirmed the efficacy of the probiotic in modulation of the microbiota composition (10). The composition of this probiotic mixture was Bifidobacterium longum CECT 7347, B. lactis CECT 8145 and Lactobacillus rhamnosus CECT 8361 with a total of 1×109 colony-forming units (CFU) per capsule, formulated on maltodextrin.

Recent experimental and human case reports indicated that probiotic‐ based treatments provided impressive therapeutic and preventive approaches to treat psoriatic skin inflammation

One case study looked at the probiotic Lactobacillus sporogenes treatment of a 47 years old woman with pustular psoriasis. She was a subject of psoriasis since 15 years, and has been on medical care with various topical and systemic treatments. Patient was admitted and put on steroids, dapsone, and methotrexate, as well as supple- mentation of analgesics and antipyretics. She was not responding to traditional treatments and her lesions kept increasing and started developing signs of steroid toxicity. Therefore, medical professionals had to explore alternative medicines. All the medications were stopped and the patient was treated with the probiotic L. sporogenes.

After 15 days, the fever descended, lesions started ameliorating and no new lesions were observed. Her general conditions also improved. Probiotic treatment was continued and after 6‐month follow‐up plaque psoriasis lessened. (11)

Fecal Microbiota Transplants For Psoriasis Arthitis

Overall, patients with PsA who have participated in an RCT testing FMT find the treatment acceptable and safe encouraging more research into the field of microbiota-targeted interventions in rheumatic diseases (2)

Medications, Gut Health, And Psoriasis

Current treatment strategies in psoriasis include immunomodulating biologic agents. A variable response to this type of therapy has been reported in psoriatic patients. A possible effect of biologic therapy on the gut microbiome composition has been suggested, but data are still limited. The aim of this study was to compare the gut microbiome composition between psoriatic patients treated and untreated with biologic drugs in order to identify differences which may highlight the potential impact of the treatment on the gut microbiome. (7)

This study showed that biologic therapy may have an impact on the composition of the gut microbiome of psoriatic patients. Gut microbiome composition could be used as an indicator of response to therapy and the modulation of the microbial composition could help to restore the intestinal symbiosis in psoriatic patients. (7)

So, can gut health effect psoriasis?

All 16S rRNA gene sequencing based studies agreed that the gut microbiota of patients with psoriatic disease differed from that of healthy controls (1)

The answer then is yes, but it seems the specifics may from person to person (as is to be expected).

How do I improve my gut health to help psoriasis?

• Consider probiotic therapy.
• Consume plenty of prebiotic foods (if tolerated): leeks, onion, garlic, olives etc
• Consume plenty of polyphenol rich foods (think colour): berries, green tea, green peppers, dark chocolate, coffee, tomatoes etc
• Consume plenty of fermented foods (if tolerated): sauerkraut, kombucha, kimchi, kefier
• Consider a trial removing dairy products
• Consider whether stress might be contributing to your health issues.
• Spend as much time outside as possible, ideally in nature.
• Consider a Healthpath gut microbiome test, SIBO test, leaky gut test.

More specifically a paper entitled ‘Nutrition and Psoriasis’ listed the below as key considerations based on the evidence as they ameliorate psoriasis via the suppression of inflammatory pathways, or, induction of regulatory T cells:

• Omega 3: salmon, mackerel, sardines.
• Vitamin D: sunshine!
• Vitamin A (retinol): liver, eggs, butter, fish
• Vitamin B12: fish/shellfish (ark shell, oyster, clam, or salmon roe) or liver (beef, pork, or chicken)
• Short chain fatty acids: metabolites of bacteria fermenting our dietary fibre. One of them, called butyrate, is also found in butter and ghee.
• Selenium: fish/shellfish, eggs, poultry, grains, Brazil nuts,
• Genistein: soybean
• Dietary fibers
• Probiotics: whether from fermented foods or supplements (ideally both)

Supplements For Psoriasis:

• Selenium
• Cod Liver Oil (good source of omega 3 and retinol)
• Vitamin D
• Vitamin B12
• Probiotic: needs to be specific for your needs. A good general broad spectrum option is this one.
• Zinc

References

1. Characterization of the Oral and Gut Microbiota in Patients with Psoriatic Diseases: A Systematic Review (click here)
2. Experiences and perceptions of patients with psoriatic arthritis participating in a trial of faecal microbiota transplantation: a nested qualitative study (click here)
3. Inflammatory bowel disease and psoriasis: modernizing the multidisciplinary approach (click here)
4. Psoriasis and Gut Microbiome-Current State of Art (click here)
5. Deciphering Gut Microbiota Dysbiosis and Corresponding Genetic and Metabolic Dysregulation in Psoriasis Patients Using Metagenomics Sequencing (click here)
6. Dysregulation of the gut-brain-skin axis and key overlapping inflammatory and immune mechanisms of psoriasis and depression (click here)
7. Gut microbiome profile in psoriatic patients treated and untreated with biologic therapy (click here)
8. Psoriasis Is Associated With Elevated Gut IL-1α and Intestinal Microbiome Alterations (click here)
9. Effects of Probiotic Strains on Disease Activity and Enteric Permeability in Psoriatic Arthritis-A Pilot Open-Label Study (click here)
10. Efficacy and Safety of Oral Administration of a Mixture of Probiotic Strains in Patients with Psoriasis: A Randomized Controlled Clinical Trial (click here)
11. Probiotics with ameliorating effects on the severity of skin inflammation in psoriasis: Evidence from experimental and clinical studies (click here)