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:

• Fruits
• Vegetables
• Healthy fats (like olive oil)
• Seafood
• Legumes
• Nuts and seeds

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.

Can It Help Psoriatic Arthritis?

Here are some of the ways that following a Mediterranean diet could potentially improve psoriatic arthritis symptoms:

• The Mediterranean diet emphasizes foods high in omega-3 fatty acids, (found in fish like salmon or sardines, nuts like walnuts, and seeds like flaxseeds and chia seeds). These omega-3 fatty acids may help reduce inflammation and joint stiffness, says Nilanjana Bose, MD, a rheumatologist at Lonestar Rheumatology in Houston.
• Olive oil, a major component of the Mediterranean diet, contains healthy polyphenols (plant-based compounds) but also oleic acid, which has been shown to have an anti-inflammatory effect.

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• Red meats and refined sugars, which are both considered inflammatory foods, are limited in this diet, says Shailendra Singh, MD, director of rheumatology at Unity Health Rheumatology in Searcy, Arkansas.
• The Mediterranean diet is a well-balanced diet, containing fresh, whole foods, in contrast to the average American diet, which is often loaded with fast foods and unhealthy fats.
• Research shows that a Mediterranean-style diet, largely due to an increased intake of vegetables, fruits, legumes, and fermented dairy products, leads to favorable changes in gut health — which is increasingly thought to be related to the development and progression of autoimmune conditions like PsA.

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• Adherence to the Mediterranean diet has been found to decrease the severity of psoriasis, according to a review of research.

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• A study found that a Mediterranean diet, when combined with exercise, improved outcomes in people with PsA, independently of weight loss.

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What to Consider Before You Try It

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.

• Lean meats
• Fish
• Vegetables
• Fruits
• Nuts
• Seeds

Foods that are not considered part of the paleo diet include grains, legumes, dairy products, potatoes, refined sugar, salt, and highly processed foods.

Can It Help Psoriatic Arthritis?

Like the Mediterranean diet, this diet is high in anti-inflammatory foods such as:

• Fish
• Nuts and seeds
• Fruits and vegetables

And it restricts foods thought to cause inflammation, such as:

• Refined sugars
• Processed foods
• Fatty cuts of meat

The paleo diet “encourages food in its original, unprocessed form, and those who follow this diet tend to cook more,” says Gibofsky.

What to Consider Before You Try It

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.

Can It Help Psoriatic Arthritis?

There is some evidence that a vegetarian or vegan diet may have benefits for people with psoriatic arthritis:

• Vegetarian diets may lower inflammatory markers in the body. A meta-analysis of 18 studies evaluated vegetarian diets compared with omnivore diets on circulating levels of inflammatory biomarkers, and found that following a vegetarian diet for at least two years was associated with lower levels of C-reactive protein, a key marker for inflammation in the body.

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• They may lead to a reduction in arthritis pain. A meta-analysis of seven studies found that anti-inflammatory diets — including vegetarian and vegan — significantly lowered pain, compared with ordinary diets, in people with rheumatoid arthritis, an inflammatory form of arthritis (as is PsA).

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What to Consider Before You Try It

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.

Why Might It Be Good for Psoriatic Arthritis?

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.

What to Consider Before You Try It

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).

Can It Help Psoriatic Arthritis?

What to Consider Before You Try It

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.

• While no specific diet has been proven to directly impact psoriatic arthritis, anti-inflammatory diets like the Mediterranean may help alleviate some symptoms due to their emphasis on nutrient-rich fruits, vegetables, and healthy fats.
• It's important to ensure an adequate intake of nutrients such as protein, calcium, vitamin B12, and iron, as restrictive diets can often lead to nutritional deficiencies.
• If you suspect you have food sensitivities or have persistent digestive issues alongside psoriatic arthritis, consulting a healthcare professional to explore dietary adjustments could be beneficial in managing symptoms.
• Consider working with a nutritionist to ensure that you’re getting all the nutrients you need as part of a well-rounded PsA management strategy that also involves medication, regular exercise, and stress management.

Additional reporting by Nina Wasserman.