Autoimmune Roots

Psoriatic Arthritis Diet

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by

Psoriatica
in

History of my Psoriatic Arthritis Diet

Science will soon provide us with a prescriptive Psoriatic Arthritis Diet. I have experimented with Paleo diets, Autoimmune diets, a Gut Health Protocol and I am now settling into my own version of a Psoriatic Arthritis Diet that I will continue to tweak as I learn. I keep a spreadsheet of the books I read and what foods they recommend. Then I update my own Psoriatic Arthritis Diet based on my new knowledge. You’ll want to review the supplements and elimination protocols I have tried to get me to this ideal, recommended diet.

Update March 2020: I am still reintroducing foods after a 5-day fast and 21-day elimination diet that cured my Disseminated Zoster and has allowed me to live without an autoimmune medication. I am going to update each food category below to incorporate what I have learned so far.

Meat

Update March 2020: I am decreasing the amount of meat in my diet. I realize that I feel better when I eat less meat. It is hard to do now that more people at home (coronavirus) and I am cooking more for others but whenever I can I eat a vegetable forcused meal.

I eat meat almost every day, often in very small quantities, but I am also fine if I have a day without it. Seafood is my primary protein but I eat almost any kind of protein,  including venison, which I know is bad for my gout, but is plentiful where I live. Venison is limited to once a week or less and I avoid processed meat.

During the elimination phase: I only eliminated processed meats and still avoid them.

Vegetables

I love vegetables and have no problem eating them daily. I love broccoli and kale so those are in my diet almost daily. Breakfast often consists of either a smoothie (with kale or spinach) or a vegetable hash with 2 eggs. I try to make vegetables the primary ingredient of every meal with the protein treated as a “side”.

During the elimination phase: When I did my elimination phase I included some starches like sweet potatoes in my diet. If I try another elimination round to try to discover what foods are still causing me inflammation, I will probably eliminate all starchy vegetables for a brief period.

Nightshades (hover list of nightshades)

I have not yet experimented with removing nightshades because I eat them almost daily! If I eat eggplant several meals in a row I will get diarrhea, so I know too much of eggplant causes digestive distress. The problem is I grow my own tomatoes and eat them at every meal in the summer. I’ve discovered I feel a little better if I roast them or cook them briefly rather than eating them raw. I know I need to refine my Psoriatic Arthritis Diet to identify & eliminate some nightshades. I’m hoping to have the discipline to do that this winter (when none of them are in the garden).

Update March 2020: I did remove nightshades for over a month and did not have symptoms when I added them back. I think I just can’t over do it with any single vegetable.

Starchy Vegetables (potatoes, sweet potatoes, yams, parsnips, tapioca, carrots, root vegetables)

If my husband cooks dinner he will often include potatoes and I have gradually allowed them back into my diet in small quantities now that I am healthier. This is where keeping a daily food diary keeps you honest because as I observe my food diary, I realize I eat potatoes quite often now.  I’ll need to remove potatoes when I test nightshades. I eat carrots regularly and they do not seem to bother me, so I plan to keep them in my diet.

Fiber

Some diets go into incredible detail on Soluble Fiber, Insoluble Fiber, and Resistant Starch. Some recommend supplements in these areas to make sure you get enough of the specific types. I do not take any fiber supplements, but I do get substantial fiber from my foods. I will consider a fiber supplement if I ever get to a place where I can’t improve my microbiome with whole foods alone.

Fruit

I eat fruit daily, mostly in my morning smoothie or for an afternoon snack. Fruit does a great job of satisfying a sweet tooth as you are weaning off refined sugar and it satisfies hunger because it has fiber in it. I knew that darkly pigmented fruit was important, but The Keystone Approach by Rebecca Fett book discussed the importance of polyphenols and antioxidants in a Psoriatic Arthritis Diet, so I am including something darkly pigmented in my smoothies each morning.

Sugar

This is tricky because natural sugar is present in a lot of food. I do not avoid natural sugar. I do avoid added sugar, which means anything processed. In the beginning, I was extremely strict about this. Sugar is so addicting that it must be removed from ALL food before you can break the addictive desire. When I started this diet, I had no idea how much sugar I was eating. My habit was to eat something sweet after every meal. The good news is that I was extremely disciplined to always eat my healthy foods before my sweets, but I still consumed some chocolate, ice cream, or a cookie after almost every meal.

Update March 2020: I’ve gradually allowed sugar back into my diet after almost 3 months with almost none. I think it may be causing my Psoriatic Arthritis to flare slightly.

Honey

I only eat honey incidentally. Honey is in a separate category because it is a monosaccharide, while most other sugars are disaccharides. If your gut is extremely damaged or you have Crohn’s then you’ll need to dig deeper on this subject. A damaged gut is unable to break down disaccharides into monosaccharides and the body cannot absorb a disaccharide. Honey is the only monosaccharide sweetener, so it is the only one that can be used while healing a damaged gut. Breaking the Vicious Cycle website is an excellent resource to learn more about the types of sugars.  But in general, try to wean yourself off sugar!

Wheat, Rye, and Gluten Based Grains

Update March 2020: I have a gluten allergy and stopped all gluten late November 2019.

Then: Gluten was a significant part of every single meal prior to 2017. Breakfast had eggs wrapped in a tortilla or buns. Lunch was processed meat between bread. Evening meals always had either a grain or a potato starch. A meal wasn’t complete without grains! My biggest weakness was the cookie. Sugar + starch is a deadly combination for me. I could not resist a cookie at a meeting and I almost always took one to go. Sweets (which often contained gluten) were also a daily ritual after every meal. That was the hardest habit to break and I strongly recommend breaking it without trying to recreate the “cookie” or “muffin” with a paleo hack recipe because that approach does not change your habits. You must break the habit loop!

Now: I can’t believe it, but I almost never eat grains. I am currently well enough that a little bit of gluten does not make my gut bacteria go wild. I can now eat out without too much worry, but I always ask if a restaurant will substitute any salad or vegetable for the rice/bread/starch.

During the elimination phase: I did not eat grain, pseudocereal, rice, soy or legumes.

Genetically Modified, Roundup (glyphosate) Ready grains

I stumbled across some startling research in this area that links the timing of the increase in autoimmune diseases with the introduction of round-up ready seeds. I have not taken the time to dig into this enough to draw my own conclusions, but I do believe it is worth studying. It is important to draw a distinction between the 2 different ways this could affect human digestion because concerns are often discounted without thinking through the two following scenarios as potentially impacting digestion in different ways.

  • My personal logic tells me that genetically modified seeds are not inherently bad. We’ve been cross-pollinating our foods for many generations more than this autoimmune phenomenon. Not all genetically modified foods are bad, but at times, if we genetically modify to allow us to pick the plant before it is ripe so we can transport it, then it might be affecting the nutrient and starch content of the food by short-circuiting nature’s ripening process.
  • The other scenario involves the application of the roundup to the plant. When a roundup ready crop produces fruit and is sprayed with roundup prior to harvest, we are undoubtedly ingesting some roundup, which is an herbicide. Once in our bodies, that herbicide, that is designed to kill weeds growing out of the ground, probably has the capacity to kill some bacteria in our gut as well. It is classified as low toxicity by the EPA, and that is probably the case in low doses. But if we consume grain-based foods at every meal that have been produced with roundup ready seeds, then my hypothesis is that we are tipping the dosage over some threshold that might cause autoimmune triggers. I hope some scientist reads this!

Pseudocereals (quinoa, amaranth, millet, teff)

Update March 2020: Quina caused me mild psoriasis flares so I am keeping it out of my diet for now.

When I first discovered quinoa I thought I’d found my superfood. I love the way I feel after eating quinoa. I’m sad that so many of these diets do not approve of it. I have dutifully cut it out of my Psoriatic Arthritis Diet, but I am paying close attention to the research because even before I took gluten out of my diet, I was aware of how great I felt after a quinoa meal. I’m still wondering if there isn’t something great about it for me personally so I may add it back & experiment when I’m not changing anything else.

Legumes

I always felt bad after eating most legumes. A long time ago I felt pressure to eat them in lieu of a protein, but they make me very bloated, and the gastric distress lasts for a couple days. I even believe they irritate my psoriasis as I eject what is left of them after they pass through my gut! I may eat a few when mixed with a Mexican food dish, but generally, I avoid them. There are a few exceptions. I make a navy bean soup recipe that doesn’t seem to bother me. I also seem to do okay with lentils in small doses. But in general, legumes are not part of my Psoriatic Arthritis Diet.

Rice

I didn’t eat rice back when I was eating cookies because I thought rice had no nutrition and was just empty calories. Then I went through a phase of only eating brown rice (my family was not pleased with me). The only time I eat rice now is in small quantities with a stir-fry, which is not even once a week. I have never noticed digestive distress after rice. In fact, I prefer Asian foods over almost any other type of food.

During the elimination phase: I did not eat rice.

Sticky Rice

I did not realize this was a completely different type of starch until I read The Keystone Approach by Rebecca Fett. I love sushi, so I am thrilled to know that sticky rice is more easily digested. It is not a part of every Japanese meal I eat. For example, if I eat sashimi, I don’t need rice, but it is nice to know that this is an option.

Soy or Soybean

Update March 2020: I only eat gluten free soy or Tamari.

Soybeans were a superfood for a period and I ate them regularly. They were not part of the elimination phase in 2017. I don’t seek them out now, but I also don’t avoid soy sauce 100% of the time. I don’t cook with it or use it in my own sauces & dressings at home, but when I eat out I don’t worry about it. So, I am consuming small amounts of soy.

During Elimination Phase: I did not eat it. There are lots of other potential issues with soy that are quite complex, so it should really be avoided while trying to get your gut healthy.

Dairy

Update March 2020: I need to avoid dairy but it is hard. I have traces of it, allow an occasional cheese on a salad or in a dressing, but I do not eat yogurt as a food group anymore. Dairy makes it easy to make foods taste good so I do miss it as a cooking resource.

Then: Yogurt was a big part of my diet prior to my elimination phase. I thought I was making a healthy choice because I only ate plain unsweetened yogurt. I’m pretty sure my body was struggling with digesting it though because I recall times when I experienced digestive distress after eating yogurt.

During the elimination phase: I cut out all dairy products for about 30 days.

Now: I love goat milk kefir. It is easier on my tummy than regular cow’s milk kefir. I eat a very small amount (1/2c) with blueberries as a snack and it is amazing. Cheese is not an essential part of my Psoriatic Arthritis diet and I now leave it out of almost all recipes, although I do eat it when it is served as an appetizer. Yogurt is currently not a regular food. The fermentation time that is discussed in the Specific Carbohydrate Diet (SCD) is probably a big deal for me so I either need to make it myself or skip it. At this point, I do not miss it so it isn’t a part of my Psoriatic Arthritis Diet.

Nuts

Nuts were my go-to food during my elimination phase, but I knew nothing about their starch content or the problems with a high Omega 6 to Omega 3 ratio. They didn’t cause me noticeable problems and they satisfy me. Cashews are especially helpful because they are naturally sweet when you are weaning off sugar. But now that I am in a more stable phase, I limit my nut consumption. Cashews and peanuts are the highest starch nuts. Some nuts can contribute to immune processes in the body. For my long-term joint health, I now know that I need to get my Omega 3’s higher than my Omega 6’s (nuts are relatively high in Omega 6). And it is possible that some nuts are causing an immune activation process in my body that is delayed and that I don’t associate with the joint pain. I eat nuts and trail mix as an occasional snack, but not daily like I used to. It is another food that I need to eliminate completely and then add back one at a time while I am not changing anything else.

Seeds

This is another area that I should probably explore more but it will be a low priority for me. I think the only seeds that I eat with any regularity are pumpkin seeds on salads.

Nut Flour or Seed Flour

I started using almond flour last Christmas in my baking. I didn’t notice any major problem that could only be blamed on the nut flour. Everything also had sugar in it, so I was suddenly putting lots of sugar in my body too and generally considered the sugar to be the culprit when I felt digestive distress. Nut and seed flours are not allowed on the SCD diet because the concentration is too high. In general, I avoid making foods that require a lot of “flour” of any sort. Now that I am stable I’ll use a small amount but I’m not making muffins and things like that anymore, so it isn’t really an issue for me on a day to day basis.

Fats

Update March 2020: Fats will become my new frontier. I’ve watched Forks Over Knives documentary and I now regularly download recipes from their website. I have not yet started cooking with zero fat, but I am learning and reducing when it doesn’t add much to the flavor.

The subject of fats is complex and controversial. Most fats contain some amount of each of the various types of fat. It is virtually impossible to eat only monounsaturated fat. You must do the best you can with the goal of raising your awareness about the fats you are consuming. I currently eat mostly olive oil. I don’t eat bacon or butter regularly, but I use them to add flavor & richness to some recipes. Be very careful and pay attention to the source of your information. This table in Wiki looks informative but I was stumped that Sunflower Oil was so high in monounsaturated fat. Further reading clarifies that this is for a high oleic (lower LA) type of sunflower oil that we probably are not seeing in the grocery stores.  Below are my latest notes on each of these fat categories.

During the elimination phase: I ate mostly coconut oil because the diets at that time promoted it as gut healing.

Saturated Fats, generally stable at high heat

Butter (low heat because of solids), Ghee, Tallow (beef fat), Lard, Duck Fat

If our fats are coming from animals raised on roundup ready grain, rather than grass, then even our saturated fats may have a high Omega-6 to Omega-3 ratio. I’m starting to think about this more, watch for it in my diet & avoid some saturated fats.

Saturated fat, Medium Chain Triglycerides (MCT)

Breast milk, Coconut Oil

I used coconut oil exclusively during my elimination phase. I am now reading of some reasons to avoid it; however, I think it was important during the healing phase. MCTs are more easily digested. They are broken down in the liver and can be used for energy rather than put in storage. Long-chain triglycerides are absorbed in the lymphatic system. This is a great explanation of the nuance of MCT or coconut oil. The only book that advised against coconut oil is The Keystone Approach. Since it is focused on a Psoriatic Arthritis Diet I am taking that as my current recommendation and will remove coconut oil from my Psoriatic Arthritis Diet. It also sounds like the basic stuff at the grocery store may not be what I think it is.

Monounsaturated Fats generally use at low temperatures

Olive, Avocado, Eggs, peanut (high omega 6), almond, lard (pork fat)

Polyunsaturated Fats generally oxidize easily so best not heated.

Sunflower, corn, soybean, flax, safflower, sesame, vegetable, walnut, grapeseed

These fats are all generally high in the Omega-6 Linoleic Acid. We need some LA in our diet, but some say these oils are so prolific that we now get too much. I now avoid these for 2 primary reasons.

  • They are high in the Omega 6 Linoleic Acid and we generally get too much Omega 6 in our diet because of the food industry’s prolific use of it in everything. I need to increase my Omega 3 intake.
  • They are unstable and oxidize during their production, time on the shelf, and when heated.

The Omegas

Omega 3

There are 3 types of Omega 3 fatty acids

  • ALA (Alpha-linolenic acid) is a short chain, essential Omega 3. The label “essential” means the body requires it but doesn’t easily produce it. We must obtain it from our food. Animals consume it but can’t use it, so they convert it to DHA. ALA Is found in plant oils such as flaxseed, soy, canola and walnut oils.
  • DHA (Docosahexaenoic Acid) is a long chain Omega 3 that is anti-inflammatory and good for the nervous system. The best source of DHA and EPA is cold water fatty fish such as salmon, mackerel, herring, sardines, anchovies, bass, shellfish.
  • EPA (Eicosapentaenoic Acid) EPA & DHA are often lumped together but they are actually very different and have a different impact on inflammation. The more EPA you have, the less AA you will produce. This is a great article explaining the difference between the two. https://www.psychologytoday.com/us/blog/in-the-zone/201204/what-are-the-real-differences-between-epa-and-dha

Omega 6

There are also 3 types of Omega 6 fatty acids. Omega 6 fatty acids are also necessary for survival and important for our brain, muscles, and hormones, but they can also cause inflammation.

  • LA (Linoleic Acid) is the essential Omega 6. A lot of diets are telling us to avoid it because we get too much in our diet in relation to Omega 3s. But these two studies that do not find a link between higher LA and inflammation.
  • ARA (arachidonic acid) is a long chain Omega 6 and can act as a precursor to inflammatory mediators. It is highest in walnut oil, wild rainbow trout, egg yolk, farmed tilapia, liver, and bacon. ARA should not be eliminated from our diet though because conversion of ARA into those inflammatory mediators is regulated by other things like antioxidants and omega-3 fatty acids. It isn’t only consumption that affects the ARA in our bodies.
  • GLA (gamma linolenic acid) There is some research that shows GLA can interrupt the inflammatory cycle of psoriasis. However, the human testing used very high doses as a dietary supplement and there have been no long-term studies to see if it works at lower doses and there is concern that higher doses could cause other health problems. I do not take a GLA supplement, but I do use Borage Oil topically on my psoriasis when I have an outbreak. It does give me relief, and the psoriasis subsides, but it is possible any concentrated oil would have the same effect!

The bottom line: there is a definite link between fatty acids, psoriasis and psoriatic arthritis as this recent study also shows. Research is continuing to find connections, but it is difficult to know how to adjust our diet to help with our individual disease. My current approach is to eat whole foods as minimally processed as possible

Coffee/Tea

Update March 2020: I stopped coffee in November and have not restarted. I only drink it when I’m driving and very sleepy. I do drink all types of tea daily.

I currently drink 2-3 cups of coffee daily, but only drank 1 cup/day during my elimination diet. I wasn’t a big tea drinker until my elimination diet when tea was an excellent substitute for alcohol! Now I drink a cup of tea almost daily.

Alcohol

Update March 2020: I stopped drinking November 2019. Since then I have had alcohol while on 3 trips and occasionally for a special event. I want to keep it out of my diet. I know if I start drinking that I will easily make it a daily habit again.

This is my biggest weakness. I suspect excessive alcohol consumption is what caused my initial SIBO although no one asked me any questions about how much alcohol I drank. It’s like the elephant in the room. No one wants to address it. But I think we have a serious problem in our society. I drank daily this summer but aim to reduce to drinking to 3 nights a week this fall.

Chocolate

Update March 2020: I’m waiting to add this back. The few times I’ve tried it I have experienced digestive distress.

I love it and eat it rarely, but depending on the quality of the chocolate, I will experience some level of digestive distress.

Fermented foods

I grew up eating homemade sauerkraut…I remember the smell, the crock, everything. You would think I’d have enough good bacteria hanging around from that upbringing. But I consumed zero fermented foods over the next 25 years. Reading about the importance of fermented foods in Brainmaker and Gut Health Protocol was new info for me. After the elimination phase, I incorporated fermented foods into my diet on an almost daily basis. Since reading about the potential for an unpredictable effect on gut bacteria and the potential to incorporate unwanted yeasts into my microbiome I backed off. But I’m not cutting them out completely because I think they do make me feel better at times.

Super Foods

I learned to be very skeptical about each new “superfood” that comes out. Whatever the latest smoothie craze may be.  I incorporated many of these into my diet but only now realize they may be causing me problems. Many have some element that is beneficial to us, but logic tells me we were never intended to eat these foods daily or in large quantities. So be careful incorporating them into your diet. Almost none of these are allowed on the SCD diet because they are either a starch, mucilaginous or some sort of gum.

  • Acai Berry-often mixed with acai gum.
  • Algaes
  • Camu Camu Berry
  • Chia Seed-polysaccharide, mucilaginous
  • Flax Seed-polysaccharide, mucilaginous
  • Goldenberry
  • Goji Berry
  • Hemp-polysaccharide, mucilaginous
  • Maca-starch, mucilaginous
  • Macqui Berry
  • Mulberry
  • Sea Vegetables: Dulse, Kelp, Nori, Wakame, Carrageenan-starch & mucilaginous
  • Sacha Inchi
  • Yacon-high inulin, complex sugar so not allowed on SCD

Probiotics

Update March 2020: I currently take a daily probiotic but I’m varying which one because I’m finishing up all my old probiotics before buying any more.

I go back and forth on probiotics and how they affect me. They are unregulated, so we can’t be confident about what is in them. We can’t trust what they say they’ll do on the bottle, which means we must do our own research and that is tough. I started with a refrigerated one from Whole Foods called Garden of Life Raw Probiotics, which had no effect. Align made a HUGE difference but I can only take them 1 or 2 days in a row or I get constipated! I currently take L-Glutamine in a cup of water in the morning and notice a big difference in my bowel movements. It isn’t a probiotic, but it affects clostridia & butyrate which allows the good bacteria to flourish in the proper spot in my intestine. L-Glutamine was a part of the Gut Health Protocol in 2017. I stopped but decided to start again while healing from my current surgery as it is supposed to be good for muscles too. It is not good for long periods so my current plan is to stop after I am fully healed from my two foot surgeries. I started the Jarrow Bifidus Balance Probiotic recommended in the Keystone Approach but it is too soon to draw any conclusions.