Do Keto Diets Help Psoriasis?

Do Keto Diets Help with Psoriasis?

The keto diet is one of the most popular diets for those trying to lose excess fat. It is also well known for its positive health benefits for conditions such as epilepsy, diabetes and Alzheimer’s disease.  But how does the evidence stack up when it comes to the keto diet and psoriasis?

Given psoriasis is associated with increased rates of metabolic syndrome and obesity, one might assume that any successful weight loss regime is a good one.  However, a recent study has shown this may not be the case when it comes to keto.

The evidence

According to co-lead investigator, Barbara Kofler PhD, it’s all in the types of fats.  A well balanced keto diet rich in long chain triglycerides such as olive oil, fish, nuts and avocado, did not worsen skin inflammation, however it also did not improve the skin. In addition to this, a keto diet rich in medium chain triglycerides such as coconut oil, increased skin inflammation.

The other concern over keto diets and psoriasis is when they are not followed consistently.  High fat consumption combined with substantial carbohydrate consumption was also shown to promote the progression of psoriasis- like skin inflammation as well as spontaneous dermatitis in mice.

Several other studies on diet and psoriasis have also confirmed high fat intake to worsen psoriasis inflammation, such as the amounts associated with the typical Western Diet.

The Verdict

So what is the best diet for psoriasis?  Our PEC nutritionist recommends those with psoriasis to follow a modified Mediterranean style diet with plenty of olive oil, fresh fish and plant foods and less processed foods and animal proteins such as eggs and meat.  Read more about the benefits of fresh fish and psoriasis here


  1. Felix Locker, Julia Leitner, Sepideh Aminzadeh-Gohari, Daniela D. Weber, Philippe Sanio, Andreas Koller, René Günther Feichtinger, Richard Weiss, Barbara Kofler, Roland Lang. The Influence of Ketogenic Diets on Psoriasiform-Like Skin InflammationJournal of Investigative Dermatology, 2019; DOI: 10.1016/j.jid.2019.07.718

Stress and Skin Flares: Why does it happen and what can you do about it?

Stress and Skin Flares: Why does it happen and what can you do about it?

Jessica Simonis – Nutritionist, Western Herbalist

Stress creates illness and illness creates stress.  It’s a cycle that so many with chronic skin issues struggle to break free from. 

Despite this, stress management often falls to the bottom of the list of “must do’s”, together with the rest of those things we know we should do but for some reason, don’t. 

…but I don’t feel stressed?

Many associate stress with mental/emotional symptoms such as worries, fears, anxiety and depression, not realizing that physical stress is equally as important.  Regardless of whether your stress is emotional or physical, your body responds in the same way; by activating your fight-or-flight response.  Common physical stressors can include long working hours, disrupted sleep, infection, surgery, poor diet and nutritional deficiency to name a few; AKA ‘burning the candle at both ends’.

Common symptoms of stress include:

  • High or low blood pressure
  • Unexplained weight gain or loss
  • Digestive discomfort
  • Irritable moods
  • Menstrual irregularities or infertility
  • Poor sleep onset or latency
  • Muscle tension
  • Headaches
  • Fatigue
  • Brain fog
  • Flaring of your autoimmune condition!

If you are experiencing at least 3 of these symptoms, chances are your mind and or body is stressed.

What can I do to manage my stress more effectively?

We are often told by health practitioners to manage our stress, often without the tools and strategies to do so.  Most of us are familiar with stress reduction techniques such as breathing exercises, yoga and meditation, but if these aren’t working for you (or perhaps don’t float your boat), what else can you do to keep your stress levels at bay?

Effective stress management is essentially about improving your resilience (eg. healthy diet, nutrition, regular sleeping hours, exercise, deep breathing) and reducing your stress load (saying no, cutting back, taking a break, eliminating your stressors).  It takes two to tango. Everyone has a certain level of stress tolerance. Some of which is determined by genetics and the rest by our environment.  The less stress tolerance you have, the less it takes to overwhelm your body and cause illness.  For someone with skin disease, this can mean frequent flaring, poor response to medication and difficulty in achieving remission.

For those with a slightly larger stress tolerance, it generally takes more to flare their condition.  This is not always a good thing as it can enable them to ‘push the boundaries’ so to speak, to see just how much they can get away with.  On the up side, small changes can often lead to quick and significant results. 

Regardless of your stress tolerance, implementing the below techniques will help you improve your resilience, step by step.  It can take time, like building a muscle.  With a focus on stress management and stress resilience, you can help to finally break the cycle of stress flaring.

Top tips for stress management (yes they are practical!)

  • Identify and address food triggers – food triggers create a physical stress and increase inflammation.  An elimination and re-challenge diet is often the most accurate way to determine food triggers
  • Set a strict sleep routine:  Set an alarm to remind yourself when to go to sleep and when to wake up.  Routines create a predictable environment for the body which in turn reduces stress.
  • Exercise daily – even if it is only a gentle walk around the block or 5 minutes of stretches.  The gentler the better for those in a flare, however some daily movement is essential.  This can be built up over time as resilience increases.
  • Sunshine – those with skin disease often spend more time indoors or covered up – whether due to fatigue, pain or the visible signs of their condition.  Sunshine is critical to provide vitamin D and vitamin D is an important immune regulator for the skin and therefore taking 5-10 minutes each day to step outside and roll up your sleeves can go a long way.
  • Provide yourself with healing space –It takes a lot of energy to heal and therefore cutting back on social and work commitments where possible is often necessary to provide yourself with the time and space to heal.  Yes, you can actually say no!
  • Connect with nature – Time outside in nature helps to slow and even still the mind.  By simply noticing a bird fly by or the shape of a passing cloud – you are in the moment.  Being in the moment can be a difficult state to achieve in a busy, tech-driven world.
  • Learn to breathe again – Whilst breathing is an automatic process, our state of mind determines how we breathe.  If we are stressed, we breathe more rapidly and more shallow.  The beauty of breathing techniques is they make breathing more conscious, and by slowing and deepening the breath we can in turn influence our state of mind.
  • Perspective – Mental and emotional stress is created from our perspective.  Take death for instance.  Someone could look at the death of a loved one as a tragedy whilst another may take the perspective that they are ‘in a better place’ or ‘finally at peace’.  Try to challenge the way you currently view your stressor/s, even in the most significant life events.  Think about the language you would use for a friend who was stressed about a similar situation.  Try and use that language for yourself.  You deserve just as much care.

Stress is an important trigger in multiple skin conditions.  At the PEC, we pride ourselves on being a holistic skin clinic, going beyond symptomatic treatments to address the core triggers of your condition, and that includes stress!

Psoriasis and Fatigue


Fatigue is a common and often disabling symptom that occurs in patients with chronic inflammatory and autoimmune diseases, cancer, neurological diseases and a number of other conditions in which inflammation and/or cellular stress occurs. Fatigue may be defined as ‘an overwhelming sense of exhaustion, tiredness, languidness, languor, lassitude, and listlessness. It is a subjective feeling which is distinct from weakness, and has a gradual onset.  Fatigue can be Acute and/or Chronic (ongoing state of tiredness), that leads to mental or physical exhaustion, or both, and prevents people from functioning within normal boundaries.

There is emerging evidence that points to the innate immune system as an important ‘fatigue generator’, brought on by invading pathogens, autoimmune diseases, cancer or other ‘danger-signals’, as well as cellular stress responses. Many dermatological diseases and conditions demonstrate inflammatory or autoimmune features, suggesting that fatigue can be a common symptom in a number of chronic skin diseases. Also, psoriasis shares common pathways of immune signalling with other inflammatory diseases including psoriatic arthritis and rheumatoid arthritis (RA).1

The reduction of productivity and work capacity caused by fatigue has been studied by industrial psychologists. In these studies, the importance of physical or mental motivational factors has been clearly demonstrated. Real muscular weakness, however, cannot be detected in most individuals who complain about fatigue. The individual affected by fatigue is often unable to handle complex mental problems and tends to be less reasonable. Inferiority complexes may surface. In neurologic and psychiatric departments, anxiety and depression are frequently diagnosed in fatigued patients. 2

In one study stressed psoriasis patients, responding to a comprehensive series of questionnaires had the following physical and psychological symptoms: constant sensation of exhaustion (78.54%); memory problems (72.54%); constant fatigue (70.58%). In another study constant and excessive fatigue and the inability to work occurred in 56.86% (F) and 43.13% (M) of respondents. 3

In one clinical study researchers wanted to determine the relationship between fatigue and disease-related and psychosocial variables in psoriatic arthritis (PsA). They interviewed 499 patients attending the University of Toronto PsA Clinic using a modified fatigue severity scale (mFSS) questionnaire.  Results showed that moderate fatigue occurred in 49.5% of PsA patients and severe fatigue in 28.7%. 4

In another clinical study in plaque psoriasis patients, researchers found nearly 50% of psoriasis patients suffered from substantial fatigue. The fatigue severity was also associated with smoking, pain, and depression, but not with psoriasis severity. 5

Because fatigue is a perceived phenomenon, researchers and clinicians rely on subjective measures to indicate the patients’ level of fatigue and impact on their quality of life. It gives an overall picture of the patient and where they are at and plays a roll in determining the need for intervention or effectiveness of treatment. The 9-item Fatigue Severity Scale (FSS) is one of the most commonly used self-report questionnaires to measure fatigue. 6

The FSS questionnaire contains nine statements that attempt to explore severity of fatigue symptoms. Read each statement and circle a number from 1 to 7, depending on how appropriate they felt the statement applied to them over the preceding week. A low value indicates that the statement is not very appropriate whereas a high value indicates agreement (1 disagree to 7 agree).

FSS Questionnaire 7

During the past week, I have found that: Score
  1. My motivation is lower when I am fatigued.
1 2 3 4 5 6 7
  1. Exercise brings on my fatigue.
1 2 3 4 5 6 7
  1. I am easily fatigued.
1 2 3 4 5 6 7
  1. Fatigue interferes with my physical functioning.
1 2 3 4 5 6 7
  1. Fatigue causes frequent problems for me.
1 2 3 4 5 6 7
  1. My fatigue prevents sustained physical functioning.
1 2 3 4 5 6 7
  1. Fatigue interferes with carrying out certain duties and responsibilities
1 2 3 4 5 6 7
  1. Fatigue is among my three most disabling symptoms.
1 2 3 4 5 6 7
  1. Fatigue interferes with my work, family, or social life.
1 2 3 4 5 6 7

Circle closest to how you feel – (1 disagree, 7 agree).

FSS Scoring: Add up the circled numbers and divide by 9. ________

A Fatigue Severity Scale (FSS) score of 4 – defined as the patient is suffering from “Fatigue” and >?5.1 as suffering from “Severe Fatigue”.

Compare results with the following scores:

  • People who do not experience fatigue score about 2.8
  • People with Lupus score about 4.6
  • People with Lyme Disease score about 4.8
  • People with fatigue related to Multiple Sclerosis score about 5.1
  • People with Chronic Fatigue Syndrome score about 6.1

NOTE: The FSS might have difficulties distinguishing fatigue from depression (the influence of pain may influence scores on the FSS).

For those that have scored 5 or more it is seriously recommended that you see your practitioner and discuss the possibility as to whether you may also be suffering from depression.


  • Skoie I.M. et al.; Fatigue in psoriasis: a phenomenon to be explored; British Journal of Dermatology (2015) 172, pp1196–1203
  • Carneiro C. et al.;  Fatigue in Psoriasis With Arthritis; SKINmed. 2011;9:34–37
  • Leovigildo E. S. et al.; Stress level of people with psoriasis at a public hospital; An Bras Dermatol. 2016;91(4):446-54.
  • Husted JA, Tom BD, Schentag CT, et al.; Occurrence and correlates of fatigue in psoriatic arthritis Annals of the Rheumatic Diseases 2009;68:1553-1558.
  • Skoie I.M. et al.; Fatigue in psoriasis – a controlled study; British Journal of Dermatology; 2017; DOI: 10.1111/bjd.15375
  • Valko PO, Bassetti CL, Bloch KE, Held U, Baumann CR. Validation of the Fatigue Severity Scale in a Swiss Cohort. Sleep. 2008;31(11):1601-1607.
  • Krupp LB, et al The Fatigue Severity Scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989; 46:1121– 3.