Psoriasis affects approximately 3 percent of the U.S. population. According to Dr. Mark Hyman, founder of the Institute of Functional Medicine, the condition involves terrible suffering from scaly, itchy, inflamed and peeling skin; aching joints; burning genitals; broken nails; and the resulting depression that inevitably comes from such conditions—all of which explains why it is often referred to as “the heartbreak of psoriasis.”

The Cleveland Clinic describes psoriasis as an autoimmune condition of the skin. The immune system of people with psoriasis overreacts, causing inflammation and an overly rapid growth of new skin cells, which in turn causes a buildup on the surface that creates the appearance of scaling, but the effects are much more significant than cosmetic.

Psoriasis is associated with psoriatic arthritis, ulcerative colitis, Crohn’s disease, autoimmune thyroiditis, lymphoma and cardiovascular disease. The National Psoriasis Foundation (NPF) describes a link between psoriasis and cardiovascular disease and metabolic syndrome known as the “march of psoriasis”. Widespread inflammation may cause insulin resistance that triggers cells lining the blood vessels to malfunction, potentially leading to atherosclerosis and heart attack or stroke. The ailment also increases the risk of diabetes, obesity and high cholesterol.

Traditionally, psoriasis is treated with steroids and immunosuppressive drugs that can be harsh on the body and quite expensive while failing to address its root cause. Alternatively, the functional medicine approach is to treat the disease’s underlying causes: inflammation and triggers.

“I have psoriasis,” says Dr. Brad Shook, a chiropractic physician and member of The Institute of Functional Medicine. “I worked hard, and I’ve had my psoriasis and my autoimmunity under control and in remission. Through functional medicine, we can identify these drivers and help you to unwind this process, heal your body and then through that process of healing, you learn what the triggers were.”

Psoriasis Triggers

Functional medicine practitioners use the acronym STAIN to categorize five triggers that activate inflammation and psoriasis: stress, trauma or toxins, antigens or adverse food reactions, inflammation or infections and nutrition. Removing these triggers allows for healing.

Stress

Psoriatic patients report worsening of symptoms with stress. Modulating the reaction to stress and adding relaxation techniques can calm the inflammatory response. Practicing relaxing activities such as deep belly breathing, yoga, tai chi, prayer, meditation, visualization, Heartmath, massage, acupuncture or biofeedback can relieve stress. Exercise can also release endorphins that reduce pain perception.

Trauma or Toxins

The NPF states that physical trauma can induce the development of psoriatic plaques. Toxins such as smoking and alcohol have been shown to increase the risk and severity of the disease. Obesity may also play a role in worsening symptoms because toxins are stored in fat, which emits inflammatory cytokines. It’s recommended to maintain ideal weight, abstain from smoking and alcohol consumption, and avoid trauma. Detoxifying and removing heavy metals can decrease the inflammatory response, as well.

Antigens or Adverse Food Reactions

Studies show that a Western diet rich in sugar and fat leads to an imbalance in gut bacteria known as dysbiosis. These harmful bacteria may contribute to psoriasis. Allergens or reactions to food can cause increased intestinal permeability, or leaky gut. The most common triggers tend to be wheat and dairy.

The Chopra Center recommends the 4 R Gut Healing program. Removing foods patients are sensitive to is key to calming down the immune system, as well as avoiding sugar, wheat, dairy and processed foods. To improve the gut, replace digestive enzymes, replenish healthy bacteria with a probiotic and repair the gut lining with butyrate or L glutamine.

Inflammation or Infections

To diminish inflammation, modify the diet to include more anti-inflammatory omega-3 fats found in fish, avocado, nuts, seeds and olives, and fewer inflammatory omega-6 fats found in wheat and dairy. Look for and eradicate hidden infections. Decrease inflammation with a high-quality fish oil, curcumin, probiotics and a whole foods diet free of food sensitivities.

Nutrition

Studies show that having adequate amounts of vitamins A and D, fish oil, probiotics and zinc are important for maintaining both a healthy gut and a healthy immune response. Supplementation can be helpful in maintaining appropriate levels of these vital nutrients. Some patients using topical vitamin D products found they had effects similar to topical corticosteroids.

“When I started working at the Ultrawellness Center, I learned about how to address the root causes of a problem, not just the symptoms, and have found a new way of approaching psoriasis,” says Adonica Nichols, a psoriasis patient and a licensed practical nurse at the center, in Lenox, Massachusetts. “Living with psoriasis is still an everyday struggle for me, but I have implemented many of these changes in my diet and lifestyle over the past several months, and I am feeling better than I ever have.”

Psoriasis is a multifaceted, complex illness that may require a deeper look at the triggers. A functional medicine physician can offer a systematic approach to uncover and remove these triggers, helping patients heal from the heartbreak of psoriasis.

Board-certified in integrative, anti-aging and internal medicine, Lorraine Maita, MD is an award-winning functional medicine specialist and author in Short Hills, NJ.