Investigating Supplements for Psoriasis

Is There A Role For Vitamin D, Probiotics & Omega-3s?

Psoriasis is an autoimmune disease generally identifiable by raised patches of skin that are dry, thick, scaly, and itchy which can vary in severity and location based on a number of contextual factors including the type of psoriasis one has.

Although it manifests in several different forms, the vast majority of people (80-90%) living with psoriasis have what is known as plaque psoriasis which is characterized by patches of thick skin that are most likely to appear on the scalp, lower back, elbows or knees.

Recent data out of JAMA Dermatology suggests psoriasis is among the most common autoimmune conditions in the United States, affecting 3% of the adult population.

My professional experience tells me that the quality of life implications of skin conditions like psoriasis means there will almost inevitably be a level of eagerness to explore complementary or alternative management options.

But are these options scientifically merited? 

When I think of nutrition-related management of autoimmune conditions, there are three supplements that immediately attract my curiosity:

  • Vitamin D – Because it continues to be associated with immune functionality in humans.
  • Omega 3s -  Due to their well-characterized anti-inflammatory capacity.
  • Probiotics -  Owing to our growing understanding of the role the gut plays in immune regulation.
  • Is there a role to play for any or all of these popular supplements in the management of psoriasis?

    Let’s find out.

    Oral Vitamin D & Psoriasis 

    Vitamin D status and supplementation remains a topic of great public health interest because it is found naturally in high supply in almost exclusively one group of foods (fatty fish) and is not readily synthesized via the sun in many regions of the world, including my home country of Canada.

    Supplemental Vitamin D has been explored with some success as a protective tool against general autoimmune disease risk, and topical Vitamin D is one of a number of traditional psoriasis treatment options.

    Observational evidence also suggests that psoriasis sufferers have significantly lower serum Vitamin D levels than healthy controls and yet experimental data looking at oral Vitamin D supplementation found no statistically significant impact on psoriasis symptoms.

    Omega 3 Supplements & Psoriasis 

    Omega-3 fatty acids, particularly the long-chain varieties EPA/DHA, are similar to Vitamin D from the perspective that they are relatively elusive from the dietary perspective (once again, fatty fish).

    Their well-characterized anti-inflammatory capacity makes them of great interest in the management of a wide array of conditions, but is psoriasis one of them?

    Based on the results of a 2020 systematic review out of Nutrition Reviews, it just might reduce psoriasis severity and lesion area – but only when used in combination with traditional psoriasis treatments and not as a standalone supplement.

    The optimal dose or duration of supplemental use could not be determined, but given the elusive nature of omega-3 fatty acids and their potential benefit in this context, the findings remain intriguing. 

    With the anti-inflammatory theme in mind, it is worth noting that very limited evidence also suggests curcumin ( at 2g/day) may reduce inflammatory markers in psoriasis sufferers.

    Probiotic Supplements & Psoriasis 

    Given the autoimmune nature of the condition and the significant role the human digestive tract plays in immune regulation, it should come as no surprise that probiotic supplementation has been explored as a complementary management strategy in psoriasis.

    As of now, the evidence is limited but promising.

    A recently published RCT out of Clinical Nutrition Espen found that a multi-strain Lactobacillus probiotic reduced psoriasis severity and symptoms with an accompanying reduction noted amongst several inflammatory markers – results that support previously published controlled trials.

    Final Thoughts, And More

    I’ve tried my best to convey an articulate and accurate account of the state of the evidence around psoriasis management via supplementation but there isn’t a huge body of high-quality science to draw from as of yet.

    Interestingly, and anecdotally, of course, surveys of psoriasis sufferers indicate that Vitamin D and omega-3 supplementation (alongside eating more vegetables) are the lifestyle interventions most reported to lead to perceived improvement.

    Interestingly, reducing alcohol intake was the most reported subtractive behavior change associated with perceived condition improvement.

    These surveys are of course anecdotal in nature but remain intriguing nonetheless.

    Hopefully, you felt the same about the entirety of today’s piece.

     

    1. Hahn, J., Cook, N. R., Alexander, E. K., Friedman, S., Walter, J., Bubes, V., Kotler, G., Lee, I.-M., Manson, J. E., & Costenbader, K. H. (2022). Vitamin D and marine omega 3 fatty acid supplementation and incident autoimmune disease: VITAL randomized controlled trial. BMJ, 376, e066452. doi:10.1136/bmj-2021-066452
    2. Filoni, A., Vestita, M., Congedo, M., Giudice, G., Tafuri, S., & Bonamonte, D. (2018). Association between psoriasis and vitamin D: Duration of disease correlates with decreased vitamin D serum levels: An observational case-control study. Medicine, 97(25), e11185. doi: 10.1097/MD.0000000000011185
    3. Theodoridis, X., Grammatikopoulou, M. G., Stamouli, E. M., Talimtzi, P., Pagkalidou, E., Zafiriou, E., Haidich, A. B., & Bogdanos, D. P. (2021). Effectiveness of oral vitamin D supplementation in lessening disease severity among patients with psoriasis: A systematic review and meta-analysis of randomized controlled trials. Nutrition (Burbank, Los Angeles County, Calif.), 82, 111024. https://doi.org/10.1016/j.nut.2020.111024
    4. Chen, X., Hong, S., Sun, X., Xu, W., Li, H., Ma, T., Zheng, Q., Zhao, H., Zhou, Y., Qiang, Y., Li, B., & Li, X. (2020). Efficacy of fish oil and its components in the management of psoriasis: a systematic review of 18 randomized controlled trials. Nutrition reviews, 78(10), 827–840. https://doi.org/10.1093/nutrit/nuz098
    5. Antiga E, Bonciolini V, Volpi W, Del Bianco E, Caproni M. (2015). Oral Curcumin (Meriva) Is Effective as an Adjuvant Treatment and Is Able to Reduce IL-22 Serum Levels in Patients with Psoriasis Vulgaris. Biomed Res Int. 2015;283634. doi: 10.1155/2015/283634
    6. Navarro-López V, Martínez-Andrés A, Ramírez-Boscá A, Ruzafa-Costas B, Núñez-Delegido E, Carrión-Gutiérrez MA, Prieto-Merino D, Codoñer-Cortés F, Ramón-Vidal D, Genovés-Martínez S, Chenoll-Cuadros E, Pérez-Orquín JM, Picó-Monllor JA, Chumillas-Lidón S. (2019). Efficacy and Safety of Oral Administration of a Mixture of Probiotic Strains in Patients with Psoriasis: A Randomized Controlled Clinical Trial. Acta Derm Venereol. 2019 Nov 1;99(12):1078-1084. doi: 10.2340/00015555-3305
    7. Afifi L, Danesh MJ, Lee KM, Beroukhim K, Farahnik B, Ahn RS, Yan D, Singh RK, Nakamura M, Koo J, Liao W. (2017). Dietary Behaviors in Psoriasis: Patient-Reported Outcomes from a U.S. National Survey. Dermatol Ther (Heidelb). 2017 Jun;7(2):227-242. doi: 10.1007/s13555-017-0183-4

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