A short while ago, an ad popped up on Instagram about the connection between gut microbes and psoriasis. I wondered if there was a connection. Let’s look at the research and see if there is a connection.
Microbes are everywhere, including in us and on us. By now, I am sure you have heard that we are more microbes than humans, that microbes in our gut affect our mood, and that our brain and gut are connected through the gut-brain axis. Dysbiosis, an imbalance of the microbes in our digestive system, can lead to chronic inflammation. Dysbiosis can occur from a poor diet or stress. It is very common to have some type of stomach upset. However, chronic inflammation can lead to several health issues, including constipation or insulin resistance. Psoriasis is a result of chronic inflammation. Its cure is unknown but may be linked to gut microbes or, more accurately, the right gut microbes known as probiotics.
So, what is psoriasis? Chronic inflammation, which results in unchecked keratinocyte growth and defective differentiation, is the root cause of psoriasis, a chronic inflammatory skin disease with autoimmune pathogenic characteristics. (Buhas et al., 2022) Only about two percent of the population developed psoriasis, usually between 20 and 30 or 50 and 60. According to Evan Starkman’s article on WebMD, psoriasis equally affects men and women; it can be hereditary (1 out of 3 people tend to inherit it); more Caucasians get it than other races; and it is linked to an overactive immune system. (Starkman, 2022) Aside from causing the skin to be itchy, it can also be painful and, at times, embarrassing to have red, flaking, peeling skin. This can lead to depression as well. Psoriasis is not life-threatening, although it is associated with a slightly lower life expectancy of three to four years.
Aside from the obvious effects of antibiotics, diet greatly contributes to the gut's microbial balance. According to Buhas et al., the imbalance of the microbes demonstrated an increase in E. coli and others that are associated with dysbiosis. They further looked at diets, including the Mediterranean diet, for their anti-inflammatory effects. The results seemed to vary. But when Buhas et al. looked into probiotic research, they discovered that "the immune responses through the IL-23/Th17 axis, B. adolescentis CCFM667, B. breve CCFM1078, L. paracasei CCFM1074, and L. reuteri CCFM1132 were beneficial in alleviating psoriasis by lowering the cytokine activity." (Buhas et al., 2022) They reviewed other supplements that seem to help, as they all have various anti-inflammatory properties, including curcumin, omega-3-rich supplements like fish oil, and quercetin.
Probiotic microbes produce short-chain fatty acids (SCFAs), metabolites that “are signaling factors in the gut-skin axis and can alleviate skin inflammation.” (Xaio et al., 2022) Lack of SCFAs tends to lead to various skin irritations and could also lead to pathogenic infections. Dysbiosis affects SCFA production as well. Tests have been done to measure the effects of different SCFAs, either ingested or topically, with positive results. Since various probiotic bacteria commonly produce these, it would seem obvious to prescribe an active (not freeze-dried) probiotic with mixed cultures.
Was the ad correct? Partially. Essentially, a diet rich in anti-inflammatory nutrients, low in alcohol and carbohydrates, and rich in antioxidants seems to help, and this diet should include fermented foods with prebiotics, probiotics, and exercise. A dermatologist is the type of specialist that would help with this. If prescribed antibiotics, find another doctor. The antibiotics would exacerbate the dysbiosis. There is too much research documenting the connections between exercise, diet, prebiotics, and probiotics and slowing or recovering from this and several other skin issues.
Sources
Buhaș, M. C., Gavrilaș, L. I., Candrea, R., Cătinean, A., Mocan, A., Miere, D., & Tătaru, A. (2022). Gut Microbiota in Psoriasis. Nutrients, 14(14). https://doi.org/10.3390/nu14142970
Starkman, Evan. Who Gets Psoriasis? Sex, Age, Race, and Ethnicity. 2022. https://www.webmd.com/skin-problems-and-treatments/psoriasis/who-gets-psoraisis
Xiao, X., Hu, X., Yao, J., Cao, W., Zou, Z., Wang, L., Qin, H., Zhong, D., Li, Y., Xue, P., Jin, R., Li, Y., Shi, Y., & Li, J. (2023). The role of short-chain fatty acids in inflammatory skin diseases. Frontiers in Microbiology, 13, 1083432. https://doi.org/10.3389/fmicb.2022.1083432
Zhao, Q., Yu, J., Zhou, H., Wang, X., Zhang, C., Hu, J., Hu, Y., Zheng, H., Zeng, F., Yue, C., Gu, L., Wang, Z., Zhao, F., Zhou, P., Zhang, H., Huang, N., Wu, W., Zhou, Y., & Li, J. (2023). Intestinal dysbiosis exacerbates the pathogenesis of psoriasis-like phenotype through changes in fatty acid metabolism. Signal Transduction and Targeted Therapy, 8(1), 1-18. https://doi.org/10.1038/s41392-022-01219-0