Can a Special Diet Help You Manage Psoriatic Arthritis?
Eating a healthy, anti-inflammatory diet is part of a well-rounded management plan for psoriatic arthritis (PsA). Still, there’s no scientific evidence that any one specific diet significantly and directly impacts psoriatic arthritis, and there’s no one diet that’s right for everyone with the condition.
“Every person is different,” says Laura Gibofsky, RD, a clinical nutritionist at Hospital for Special Surgery in New York City. One person may have a gluten intolerance while another might benefit from removing nightshade vegetables.
Here’s what you should know about some popular diets for psoriatic arthritis. And remember that your diet is one aspect of your overall treatment plan, not a cure.
The Mediterranean diet is an eating plan that focuses on:
The name of this eating plan comes from the countries in the Mediterranean region such as Italy, Spain, and Greece, which have followed this type of eating style for centuries.
Here are some of the ways that following a Mediterranean diet could potentially improve psoriatic arthritis symptoms:
While the Mediterranean diet is very healthy, there isn’t a set amount of recommended fat or calories. “The use of fat is not in a regulated amount, so it’s important to watch how much you eat,” says Gibofsky.
It also involves more than what you eat. “The Mediterranean diet is not just a diet but a lifestyle,” adds Gibofsky. Other aspects of the Mediterranean way of life involve sharing meals with friends and family, which is a way of eating that is less likely to contribute to obesity, and being more physically active.
Foods that are not considered part of the paleo diet include grains, legumes, dairy products, potatoes, refined sugar, salt, and highly processed foods.
Like the Mediterranean diet, this diet is high in anti-inflammatory foods such as:
And it restricts foods thought to cause inflammation, such as:
The paleo diet “encourages food in its original, unprocessed form, and those who follow this diet tend to cook more,” says Gibofsky.
The paleo diet “lacks grains, dairy, and legumes, so there’s a lack of fiber, which keeps you regular and lowers your risk of cholesterol and diabetes,” says Gibofsky. “Constipation and bone health can be a concern.”
And while you may experience weight loss on the paleo diet — a good thing for psoriatic arthritis management — it may be due to the fact that whole categories of foods have been eliminated from the diet. From a nutritional standpoint, “there’s a difference between removing a single food that may cause symptoms and removing an entire food group,” says Gibofsky.
A strictly vegetarian diet, which focuses on nuts, seeds, grains, fruits, and vegetables, does not include meat or fish. However, some variations of a plant-based diet can include fish (pescatarian).
While a vegetarian diet includes dairy, a vegan diet is one that excludes meat, poultry, fish, eggs, and dairy, as well as anything that could be considered an animal product, such as gelatin or honey.
There is some evidence that a vegetarian or vegan diet may have benefits for people with psoriatic arthritis:
The concern with a vegetarian or vegan diet is whether someone is getting enough essential nutrients like protein, calcium, vitamin B12, and iron, says Bose. If you’re not eating meat or dairy, you’ll need to put more effort into planning your meals so that you get enough of those nutrients from plant sources.
A gluten-free diet is one that cuts out foods that contain the protein gluten, which includes any food that contains wheat, barley, or rye.
While a gluten-free diet is essential for people with conditions like celiac disease or a gluten intolerance, there’s been little solid medical evidence for removing gluten from the diet if you don’t have one of these conditions. Nevertheless, a gluten-free diet is one that’s gained some popularity in recent years among people who do not have a diagnosed gluten intolerance.
While we don’t yet have a clear understanding of whether a gluten-free diet may impact psoriatic arthritis, some people with psoriatic arthritis have reported having less joint pain after eliminating gluten from their diets, says Bose. More research is needed.
If you have symptoms like diarrhea and constipation, you may want to talk to your doctor about trying a gluten-free diet, says Dr. Singh. But removing gluten from your diet requires working with a nutritionist or a doctor trained in nutrition to make sure you get adequate amounts of fiber and other nutrients, cautions Gibofsky.
"If it isn’t something you need for a medical reason, it can be hard to stick to when you’re on vacation, at work, or at school,” says Gibofsky. “You want a diet you can stick to for life.”
This diet, created by John O. A. Pagano, doctor of chiropractic, and is based upon the premise that all types of psoriasis are caused by a buildup of toxins in the intestines.
The Pagano diet is mostly made up of fresh, organic fruits and vegetables and smaller amounts of wild meats and organic greens. It eliminates all red meat except lamb, all sweeteners, anything processed with preservatives or additives, and fried foods. It also eliminates white potatoes, chocolate, yeast, eggs, shellfish, citrus, and any nightshades (such as tomatoes, eggplant, and peppers).
As with any restrictive diet, it's possible to miss out on key nutrients when you eliminate entire categories of foods. If you wish to try the Pagano diet, it's a good idea to work with a nutritionist to make sure your diet provides all the nutrients you need.
While it’s okay to experiment with different approaches, try to avoid switching eating patterns too often. “Drastic change to metabolism could be stressful to the body and could exacerbate inflammation,” says Gibofsky.
At the end of the day, you want a balanced diet that contains the essential nutrients needed to maintain overall health. “Your body needs protein, carbs, and fat to function properly,” says Singh.
And remember: What you eat is only part of your psoriatic arthritis management plan. Making healthy lifestyle changes like exercising, managing stress, prioritizing sleep, and following your prescribed treatment regimen are all important components of a well-rounded approach.
Additional reporting by Nina Wasserman.
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