Psoriasis and Metabolic Syndrome

That dry and scaly skin patch may be psoriasis, which can be a  warning sign for other conditions.

Why is this article relevant?

1. Because psoriasis affects 1-4% of the general population (125 million worldwide)
2. A person with psoriasis is 2 times more likely to have metabolic syndrome than a person without metabolic syndrome.
3. Having psoriasis and metabolic syndrome individually raises the risk of developing heart disease.
4. A person who has both psoriasis and metabolic syndrome have worse heart attack outcomes.
5. The medications used for psoriasis can affect the other diseases that may be present in metabolic and lead to adverse effects.

What is Metabolic Syndrome (MetS)?

MetS is a group of medical conditions that include high blood sugar, hypertension, obesity, high triglycerides, and low HDL in the blood. The presence of at least 3 out of the five conditions mentioned above is enough to have a diagnosis of MetS. Mets are associated with many diseases that are common and fatal diseases like heart attacks and strokes. At the bottom is a list.

If you need to know how to say psoriasis, hear it at Cambridge Dictionary.

What is Psoriasis?

Psoriasis is an inflammatory skin condition wherein thick reddish plaques appear on the skin. It can range from mild ( <5 %) of the skin to severe (>9%). Like other autoimmune diseases like rheumatoid arthritis, psoriasis can also affect the joints.

The plaque is from the uncontrolled growth of the skin cells that do not mature properly; that is why it is not shed and becomes thick. The inflammatory cytokines play a significant role in psoriasis. A psoriatic rash is very itchy, and it can also manifest as “pockets of pus.” The nailbeds may also be affected.   Cardiovascular risk factors like hypertension, obesity, insulin resistance, and dyslipidemia are more prevalent in psoriasis patients.

The following are some of the medications for psoriasis, but they have serious side effects.

1. Topical steroids – long term use can cause thinning of the outer surface of the skin that makes it easy to tear even with a minor injury.
2. Tacrolimus and Pimecrolimus increase the risk of blood and skin cancer.
3. Apremilast causes unexplained weight loss.
4. Retinoids like Accutane (an acne drug) can cause skin irritation. They should never be used in any woman with childbearing potential because of a very high risk of developing abnormalities of the head, face, brain, and heart in the baby.
5. Vitamin D3 analogs can result in hypercalcemia that can cause potentially life-threatening cardiac complications.
6. Immunosuppressants like methotrexate can cause severe liver and pulmonary toxicity. Primarily if methotrexate and cyclosporine are used. That’s because the fatty liver, which makes the liver prone to toxicity, frequently coexists with psoriasis.
7. Cyclosporine is associated with kidney toxicity and hypertension.

Why are these medicines for psoriasis so toxic?

Since psoriasis is considered an autoimmune disease, where the body is fighting itself using its own immune system, the accepted mode of treatment is to direct the treatment towards the immune system.

The problem with that strategy is that the body’s immune system is there to fight germs, regulate healthy cell growth and death, and prevents cancer formation.

Therefore, any medicine that limits the immune system puts a person at risk for infections, uncontrolled cell growth, and cancer.

Are there any safe treatment options for psoriasis?

To answer this, we have to address the following,

1. Why is there an autoimmune reaction in the first place?
2. Where did all the inflammatory cytokines come from?

The body does not attack itself willy-nilly. Usually, when the body is exposed to a foreign substance, the immune system develops an appropriate response and kills that foreign substance. In an autoimmune condition, the immune cells that were already made mistakenly attack the body like it is a foreign invader.

What causes the autoimmunity in psoriasis?

In this book, Gluten Freedom by Alessio Fasano, the leading researcher on gluten-related disorders from the Massachusetts Hospital and Harvard Medical Schoool, Fasano stated that gluten (in wheat, rye, and barley) creates microscopic holes in the inner lining of the intestines to form a leaky gut.

The leaky gut now allows everything that is inside the intestines, whether it may be debris, foreign proteins, viruses, fungi, or bacteria to go through. This stimulates the immune cells in the fat surrounding the gastrointestinal tract to produce inflammatory cytokines to fight the invaders that passed through leaky intestines.

The increased number of cytokines then go into the bloodstream and spread throughout the body to produce more inflammation like a psoriatic rash.   Therefore, the more frequent the ingestion of gluten, the higher is the immune response, the further the inflammation.

The higher the amount of intraabdominal fat, the more immune cells they have that can make more inflammatory cytokines. If obesity is not reversed, then the inflammation becomes chronic and damages the whole body.

A study by De Bastiani and others has shown an association between celiac disease and psoriasis. People with celiac disease cannot tolerate even a small amount of gluten and manifests as diarrhea,  abdominal swelling, and pain. A meta-analysis has shown that there is an approximately 3-fold increased risk of celiac disease among patients with psoriasis.

Some people have a mild form of gluten sensitivity called non-celiac gluten sensitivity. Research by Bonciolini showed that the skin of non-celiac gluten-sensitive patients are similar to patients with psoriasis, eczema, and atopic dermatitis. This provides more evidence that gluten intake is a significant factor in the development of psoriasis.

Can a gluten-free diet help psoriasis?

In 54% of psoriasis patients who removed gluten from their diet resulted in an improvement of their symptoms. The same research showed better signs after cutting down on alcohol, sugar, and tomatoes. It should be noted that excess alcohol and sugar are significant contributors to the formation of abdominal fat that makes the inflammatory cytokines.

Another study showed that a gluten-free diet for three months decreased the antibodies directed towards celiac disease in patients with psoriasis.

The National Psoriasis Foundation recognizes that a gluten-free diet may be of benefit in psoriasis.

Can intermittent fasting decrease the intraabdominal fat that is the source of inflammation?

Yes. A study of 108 patients showed an improvement in their psoriasis symptoms after fasting for 17 hours a day for a month. Another survey of 37 patients showed a decrease in the inflammation and swelling of the fingers after a month of  Ramadan fasting.

Take Away Message

1. Individuals with a diagnosis of psoriasis should be screened for metabolic syndrome and cardiovascular disease.
2. Be aware that many other diseases may coexist with psoriasis.
3.  The medications for psoriasis  may affect other conditions present and vice versa.
4. The medications for psoriasis can have serious side effects.
5. A gluten-free diet and intermittent fasting are safe and can help remove the source of the inflammation.
6. Intermittent fasting and a gluten-free diet can help with many other diseases related to the metabolic syndrome.
7. Talk to your physician before starting any diet. Do not stop taking your medicines until you talk to your doctor.

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