Can a Special Diet Help You Manage Psoriatic Arthritis?

vegetables and food good for a psoriatic arthritis diet
Following a plant-based diet may help reduce levels of inflammation in your body.Getty Images
When it comes to living with psoriatic arthritis, eating a healthy, anti-inflammatory diet is often a part of a well-rounded management plan. Maintaining a healthy weight is also important, as being overweight can make it harder to control symptoms. What’s more, a study published in 2019 found that being overweight was associated with significantly higher psoriatic arthritis disease severity.

While there’s no scientific evidence that says eating a certain diet can have a significant and direct impact on psoriatic arthritis, some people have reported symptom improvement after making dietary changes. Meanwhile, regardless of how much your diet impacts psoriatic arthritis, eating healthy can have a positive effect on your overall health. Following a healthy diet can help reduce your risk of related health issues such as obesity, cardiovascular disease, and diabetes, according to the National Psoriasis Foundation (NPF).

But before you overhaul your entire eating plan, here’s what you should know about these popular diets.

Mediterranean Diet

A Mediterranean diet is an eating plan that focuses on:

  • Fruits
  • Vegetables
  • Healthy fats (like olive oil)
  • Seafood
  • Legumes
  • Nuts and seeds
The Mediterranean diet also focuses less on red meat and carbohydrates than a typical American diet, according to MedlinePlus.

There are also fewer sweets and desserts and butter in the Mediterranean diet.

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?

The Mediterranean diet is rich 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,?rheumatologist a Lonestar Rheumatology in Houston. One study published in 2019 also found that olives and olive oil, other components of a Mediterranean diet, also have anti-inflammatory properties and may help prevent cartilage damage due to osteoarthritis.

Meanwhile, 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.

Generally speaking, the Mediterranean diet is a well-balanced diet, adds?Laura Gibofsky, RD, a clinical nutritionist at Hospital for Special Surgery in New York City. In contrast to the American diet, which is often loaded with fast foods and trans fats, the Mediterranean diet contains more fresh, whole foods. “The more a food is processed, the less we know about what in that food might trigger inflammation, and the less we are able to control an inflammatory condition [such as psoriatic arthritis],” says Gibofsky.

In fact, adherence to the Mediterranean diet has been found to decrease the severity of psoriasis, according to a review published in 2021.

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 so much more than what you eat. “The Mediterranean diet is not just a diet but also 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.

Paleolithic Diet

Also known as the paleo diet or the caveman diet, this eating plan is modeled after what humans might have consumed some 2.5 million years ago, during the Paleolithic era. As such, a typical paleo diet is mostly composed of foods that would have been obtained by hunting and gathering rather than farming, according to Mayo Clinic.

That includes:
  • 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?

The paleo diet “encourages food in its original, unprocessed form, and those who follow this diet tend to cook more,” says Gibofsky. Like the Mediterranean diet, this diet is high in anti-inflammatory foods such as fish, nuts, seeds, fruits, and vegetables and restricts foods thought to cause inflammation, such as refined sugars, processed foods, and fatty cuts of meat.

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.”

Lack of dairy may especially be problematic since research has shown that some psoriatic arthritis medications may increase your risk of osteoporosis.

“We need dairy to protect our bones,” says Dr. Bose. Some people with psoriatic arthritis report that eliminating dairy from their diet improves gastrointestinal symptoms (and there is a connection between inflammatory bowel disease and psoriatic arthritis, according to the NPF).

However, if you don’t have trouble with dairy, eliminating it may not be beneficial and could risk bone health, notes Bose.

And while you may experience weight loss on the paleo diet — which is 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.

Vegetarian or Vegan Diet

Eating a vegetarian diet means eating a diet that focuses on plants (nuts, seeds, grains, fruits, vegetables) and occasionally includes dairy, says Gibofsky. A strictly vegetarian diet does not include meat or fish. However, some variations of a plant-based diet can include fish (pescatarian) or occasionally meat or poultry (semivegetarians).

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?

In a meta-analysis?of 18 studies published in 2017 that evaluated effects of any?type of vegetarian diet compared with omnivore diets on circulating levels of inflammatory biomarkers, researchers found evidence 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.

While it’s thought that fasting along with the introduction of a low-fat vegan diet may help improve psoriatic arthritis symptoms, there is very limited evidence to support this eating plan.

What to Consider Before You Try It

The concern with a vegetarian or vegan diet is whether or not someone is getting enough essential nutrients like protein, calcium, vitamin B12, and iron, says Bose. When your body is lacking key nutrients, it requires a lot of work to make up for it, adds Gibofsky, and that can be a problem when you have a chronic condition such as psoriatic arthritis.

“You should maximize your diet to make sure your body always has good nutrition,” says Gibofsky. “That way you can put all your energy into being healthy and managing your condition.”

Gluten-Free Diet

A gluten-free diet is one that cuts out foods that contain the protein gluten. This includes grains such as wheat, barley, and rye.

While a gluten-free diet is essential for people with conditions like celiac disease or a wheat allergy, there’s been little solid medical evidence for removing gluten from the diet if you don’t have a gluten sensitivity. 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.

According to the Mayo Clinic, in people who don’t have any type of gluten sensitivity, a gluten-free diet may still help boost energy, promote weight loss, and improve overall health. However, more research is needed to support these claims.

Why Might It Be Good for Psoriatic Arthritis?

Research on how a gluten-free diet may impact psoriatic arthritis is limited. One thing we do know? Having an autoimmune condition like psoriatic arthritis increases the odds of having another autoimmune condition — and most people who develop psoriatic arthritis also have a related inflammatory skin condition known as psoriasis. And one review published in 2021 found that people with psoriasis have twice the likelihood of having celiac disease.

However, “the reports of gluten intolerance are probably overinflated,” says Gibofsky. “There’s a large discrepancy between what’s reported and who actually cannot tolerate gluten.”

We don’t yet have a clear understanding of whether a gluten-free diet may impact psoriatic arthritis. However, some people with psoriatic arthritis have reported having less joint pain after eliminating gluten from their diets, says Bose. While the review from 2021 did report that following a gluten-free diet reduced psoriasis severity, 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 out 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.”

Pagano Diet

This diet, created by a chiropractor named John O. A. Pagano, DC, 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?

Results from a survey published in 2017 reported that people with psoriasis, some of whom had psoriatic arthritis, found that following certain diets, including the Pagano diet, was helpful for managing their symptoms.

More than half of the 1,200 respondents reported that they cut back on foods like alcohol, gluten, and nightshades and saw noticeable improvement of their symptoms. In addition to the Pagano diet, members reported other diets like the Mediterranean, gluten-free, and vegetarian diets to be helpful.

What to Consider Before You Try It

As with any restrictive diet, it’s essential that you work with a nutritionist to make sure that you aren’t missing any key nutrients that you need for your body and mind to function properly. If you think you have an issue with a particular food, talk to your doctor or nutritionist about how to best eliminate it, advises Singh.

The Bottom Line

There’s no one diet that’s right for everyone with psoriatic arthritis. “Every person is different,” says Gibofsky. One person may have a gluten intolerance while another might benefit from removing nightshades.

While it’s okay to experiment with different approaches, try to avoid switching eating patterns too much and 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, emphasizing that this can generally be accomplished without following a specific diet.

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. “Diet is one way to help symptoms and manage your condition,” says Gibofsky, “but it’s not a cure.”

Additional reporting by?Nina Wasserman.

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Sources

  1. Siebert S et al. OP0007 High Body Mass Index (BMI) in Psoriatic Arthritis (Psa) Is Associated With Higher Disease Activity in Joints and Skin, Impaired Quality of Life and More Disability: Results From the Psabio Study. Annals of the Rheumatic Diseases. June 12, 2019.
  2. Dietary Modifications. National Psoriasis Foundation. November 29, 2023.
  3. Mediterranean Diet. MedlinePlus. July 30, 2022.
  4. Marcelina G et al. Effects of Olive Oil and Its Minor Components on Cardiovascular Diseases, Inflammation, and Gut Microbiota. Nutrients. August 7, 2019.
  5. Katsimbri P et al. The Effect of Antioxidant and Anti-Inflammatory Capacity of Diet on Psoriasis and Psoriatic Arthritis Phenotype: Nutrition as Therapeutic Tool? Antioxidants. January 22, 2021.
  6. Paleo Diet: What Is It and Why Is It So Popular? Mayo Clinic. October 20, 2022.
  7. Xia J et al. Systemic Evaluation of the Relationship Between Psoriasis, Psoriatic Arthritis and Osteoporosis: Observational and Mendelian Randomisation Study. Annals of the Rheumatic Diseases. October 12, 2020.
  8. Related Conditions of Psoriatic Arthritis. National Psoriasis Foundation. December 22, 2023.
  9. Haghighatdoost F. Association of Vegetarian Diet With Inflammatory Biomarkers: A Systematic Review and Meta-Analysis of Observational Studies. Public Health Nutrition. August 24, 2017.
  10. Frey AR et al. Case Study: Water-Only Fasting and an Exclusively Whole Plant Foods Diet in the Management of Psoriatic Arthritis. International Journal of Disease Reversal and Prevention. May 5, 2020.
  11. Gluten-Free Diet. Mayo Clinic. December 11, 2021.
  12. Afifi L et al. Dietary Behaviors in Psoriasis: Patient-Reported Outcomes from a U.S. National Survey. Dermatology and Therapy. June 2017.
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