Healing the gut to treat psoriasis: the gut-skin-connection and natural treatment strategies

Psoriasis and gut health

Psoriasis is a chronic autoimmune disorder that primarily manifests in the skin, leading to the development of raised, red patches covered with silvery scales. The symptoms of psoriasis can vary from person to person, and while some may experience mild irritation, others can suffer from severe discomfort and pain. Common symptoms include itching, burning sensations, cracked skin, and bleeding.

 

Is psoriasis a gut disease?

Although psoriasis has a genetic component, there is also growing evidence of a strong link between it and digestive health. People with psoriasis have demonstrated decreased bacterial diversity, overgrowth of bacteria in the small bowel (SIBO) and increased intestinal permeability (leaky gut). They also may have sluggish liver function and a deficiency in bile acids needed for absorbing dietary fats and fat-soluble vitamins like A, D, E and K (1). Some people with psoriasis also experience inflammatory bowel diseases like Crohn’s and Ulcerative Colitis. The visible signs of psoriasis are on the skin, but the origin story is in the gut. What’s the connection? The gut impacts the skin via the “Gut-skin axis”. This is a two-way communication between the gut and the skin mediated by the immune system.

 

The science behind the gut-skin connection

 

Gut dysbiosis in psoriasis

People with psoriasis tend to have a gut microbiome that is less diverse and more prone to inflammation. This imbalance can weaken the gut lining, allowing harmful substances into the bloodstream (leaky gut) and overstimulate the immune system, all of which can trigger or worsen psoriasis symptoms. The beneficial Akkermansia muciniphilia, Lachnospira, and Faecalbacterium species often decrease, while the inflammation-promoting Escherichia and Ruminococcus species are increased.

 

The role of leaky gut in psoriasis

Leaky gut or intestinal permeability is when the tight junctions that form the barrier between the digestive system and the rest of the body allow bacterial toxins to enter the bloodstream. These toxins trigger inflammation and disruption of other body systems, including the skin. For example, the Clostridia species produces metabolites, p-cresol and phenols. These enter the bloodstream and accumulate on the skin, causing dryness, reduced skin barrier integrity and dysregulation of keratinocytes, which are responsible for psoriatic plaques. Clostridia species can become dominant in the microbiome after courses of broad-spectrum antibiotics. Skin tests in psoriasis patients show a high percentage of gut bacterial antigens (2).

 

Lipopolysaccharides (LPS) are components of bacterial cell walls with dual effects. A-LPS, produced from beneficial bacteria, helps maintain gut health and reduce inflammation, whereas their evil twin, P-LPS, are endotoxins that, in the presence of intestinal permeability, cause systemic inflammation due to alterations in blood glucose regulation and cholesterol metabolism. In psoriasis, A-LPS triggers keratinocytes to go into overdrive and form psoriatic plaques (3).

Immune system cross-talk

A common theme across research studies is that psoriasis patients show reductions in beneficial Akkermansia muciniphilia and Faecalibacterium prausnitzii. These two species produce short-chain fatty acids (SCFA), which support healthy immune system balance via their effect on immune T regulatory (Treg) cells. Imbalanced T-reg cells release inflammatory molecules (cytokines), stimulating skin cells (keratinocytes) to go into overdrive, resulting in psoriatic lesions.

 

Supporting the microbiome in psoriasis

Although psoriasis has traditionally been treated as a skin disease, its systemic immune and inflammatory aspects are now widely acknowledged. Newer medical biologic treatments such as Adalimumab (Humira) target immune inflammation after it occurs. What if we looked to stop the inflammation before it happens by addressing the root causes in the gut microbiome?

 

Diet, lifestyle, and genetics are key regulators of gut microbiome makeup. While genetics are fixed and unchangeable, we can target diet and lifestyle factors to improve the health of people with psoriasis. Understanding how the gut microbiome regulates skin health offers new, accessible and affordable psoriasis treatment options.

 

Treatment aims

• Reduce inflammation and support a healthy intestinal barrier
• Support the growth of beneficial microbes
• Remove any pathogens and reduce the overgrowth of opportunistic bacteria

Diet – building a psoriasis-friendly gut

Reduce inflammatory foods

• Refined sugars **This does not include whole fruits!!
• Saturated animal fats. Choose lean cuts of meats and include dairy in moderate amounts if tolerated.
• Deep fried foods
• Ultra-processed foods
• Alcohol

Address food intolerances

Some, but not all, people with psoriasis have intolerances to certain components of otherwise healthy foods. These can include vegetables from the nightshade family (potatoes, tomatoes, eggplant, capsicum, chilli, and Gogi berries), gluten, and dairy.

 

Coeliac disease is up to three times more likely in those with psoriasis. Even if not symptomatic, I advise my psoriasis patients to be screened for coeliac disease (4).

 

Boost healthy microbes

The overarching strategy is to increase fibre and polyphenols, which provide food for beneficial bacteria. The best source of these is plants, so include a wide variety of in-season fruits and vegetables, plus legumes and pulses. Aim to get the bulk of your fibre from whole food sources rather than supplements, as you get the bonus of all the vitamins and minerals as well.

Boosting Akkermansia muciniphilia and Faecalibacterium prausnitzii

As these two microbes are the most depleted in psoriasis, here are specific dietary strategies to increase their abundance.

 Food to increase Faecalibacterium prausnitzii

• Fruits – apples, bananas, berries, oranges, pears
• Vegetables– leafy greens, broccoli, carrots, cauliflower, Brussels sprouts
• Whole grains – oats, barley, brown rice, whole wheat
• Legumes – beans, lentils, chickpeas
• Nuts and seeds – almonds, walnuts, flaxseeds, chia seeds
• Prebiotic foods – chicory root, garlic, onions, leeks, asparagus, bananas, oats
• Polyphenol-rich foods – berries, apples, citrus fruits, grapes, green tea, cocoa

Foods to increase Akkermansia muciniphilia

• Polyphenol-rich foods – apples, berries, grapes, cocoa, green tea, coffee, dark chocolate, plums, olives
• Prebiotic fibres – asparagus, bananas, barley, chicory root, dandelion greens, flaxseeds, garlic, leeks, Jerusalem artichoke, jicama root, oats, onions, seaweed, soybean, wheat bran
• Other plant-based foods ; yams, agave, Brussels sprouts, okra, cauliflower, broccoli
• Healthy fats – Foods rich in omega-3s (fish oil, flax seeds, hemp seeds, olives) may also help.

 

There is also observational evidence that a Mediterranean-style diet reduces the severity of psoriasis. The above foods are consumed as part of this dietary pattern (5).

 

Lifestyle changes to support skin and gut health

Stress management

 

Clinically, people with psoriasis often notice that stress leads to more frequent, severe, and longer-lasting flare-ups. Stress exacerbates psoriasis by altering the gut microbiome, over-activating stress-response systems, weakening anti-inflammatory controls, and boosting skin inflammation.

 

Over time, this can lead to a cycle where stress worsens gut health, and gut problems increase feelings of anxiety. By practising stress management techniques such as relaxation exercises, mindfulness, or meditation, you help your body return to a relaxed state, reduce flare severity, and improve your quality of life.

 

Sleep optimisation

Getting enough restorative sleep is vital for a healthy microbiome in four ways.

• Promotes microbial diversity
  • Good sleep quality and sufficient sleep duration are associated with higher gut microbiome diversity, a key marker of gut health. People who sleep well tend to have more beneficial bacteria, such as Faecalibacterium prausnitzii and Bifidobacterium, which are linked to reduced inflammation and better gut barrier function.
• Regulates gut-brain axis and circadian rhythms
  • Healthy sleep helps maintain the gut-brain axis- a communication network between the gut and brain that relies on nerves, hormones, and immune signals. This axis is crucial for regulating sleep cycles and gut function. Gut bacteria follow circadian rhythms, and sleep disruptions can throw off these microbial cycles, leading to imbalances and increased inflammation.
• Supports production of key metabolites
  • Sleep helps sustain the production of short-chain fatty acids (SCFAs) like butyrate, acetate, and propionate, which are essential for gut barrier integrity and inflammation control. Poor sleep reduces SCFA production, increasing the risk of a “leaky gut” and systemic inflammation.
• Reduces Inflammation
  • Consistent, restful sleep helps keep pro-inflammatory cytokines (such as IL-6 and TNF-α) in check, supporting a healthier gut environment^[4]. Sleep deprivation, on the other hand, increases these cytokines, harming the gut lining, the microbiome and the skin.

Start getting your sleep back on track by implementing this simple 2-step evening routine.

Herbal and natural remedies

Although diet and lifestyle are the foundations of a healthy gut-skin connection, sometimes additional support can help you gain more traction. When it comes to supplements, personalised treatment plans get the best results for my clients rather than generic, cookie-cutter protocols. That’s why I recommend consulting with a qualified practitioner to ensure you get the best and safest prescription for you, especially if you are taking prescription medication, are pregnant, or are breastfeeding.

 

However, not everyone can access a naturopath or herbalist, so here are some researched supplements you might want to consider.

 

Turmeric

Turmeric and its polyphenol, curcumin, have been shown to promote microbial diversity and reduce LPS-producing bacteria and leaky gut (6). Studies have shown that turmeric’s anti-inflammatory and antiproliferative actions significantly reduced the Psoriasis Area Severity Index (PASI) (7).

 

Prebiotics

Prebiotic fibres like partially hydrolysed guar gum (PHGG) and inulin have been shown to favourably alter the composition and activity of the microbiome, specifically improving the abundance of Akkermansia species by up to five times (8).

 

Probiotics

The probiotic Lactobacillus paracaesi CNM-2116 (STII) has reduced skin inflammation and improved skin barrier function in clinical trials (2). A 12-week randomised controlled trial using a multi-strain probiotic containing Bifidobacterium longum CECT 7347, Bifidobacterium lactis CECT 8145, and Lactobacillus rhamnosus CECT 8361 showed an up to 75% reduction in PASI scores with fewer flares at the six-month follow-up (9).

 

Sulforaphane

Sulforaphane (SFN) is derived from broccoli sprouts. It acts primarily by activating the Nrf2 (nuclear factor erythroid 2-related factor 2) signalling pathway. This activation enhances the production of antioxidant and detoxification enzymes, which bolsters the gut’s antioxidant defences. By reducing oxidative stress and inflammation, SFN can prevent gut barrier dysfunction (i.e., leaky gut) and dysbiosis.

 

Microbiome testing in psoriasis

The rise and affordability of direct-to-consumer microbiome testing provide insights into your microbiome and allow more personalised and targeted prescriptions. While it’s not essential, it can be a useful tool, especially in more complex cases.

Case Studies and Success Stories

Switching to the Mediterranean diet avoided methotrexate

A 52-year-old male who had large areas of arms and legs with plaques and psoriatic arthritis for the last 15 years wanted to avoid going on methotrexate. He changed to Mediterranean diet, focusing on getting 600g of non-starchy vegetables daily and swapping butter for olive oil. He also reduced alcohol consumption significantly. After 6 months, he had an 80% reduction in the plaques, no symptoms of psoriatic arthritis, and no need for pharmaceutical medication.

 

Post-infectious psoriasis flare

A 39-year-old female had a history of mild, intermittent scalp psoriasis since her teenage years. After a bout of bad gastroenteritis, treated with antibiotics, the psoriasis worsened. Microbiome testing revealed some opportunistic bacterial overgrowth and depleted Akkermansia species. A three-month treatment program focusing on increasing dietary polyphenols, supplementing with PHGG, and using a custom liquid herbal blend saw the scalp totally clear of lesions.

 

Next steps

In summary, addressing the gut-skin connection represents a powerful, evidence-based approach to managing psoriasis. By targeting gut health through dietary changes, probiotics, and lifestyle interventions, we can reduce inflammation, support immune balance, and strengthen the intestinal barrier, all of which have been shown to significantly improve psoriasis symptoms and overall quality of life. Research consistently demonstrates that restoring microbial balance in the gut alleviates skin flare-ups and offers a safer, more holistic path to long-term skin health.

 

Book an appointment today if you’re ready to take control of your psoriasis from the inside out. Together, we can create a personalised plan to heal your gut, calm your skin, and help you feel your best.

 

Further reading

• Gut health benefits of resistant starch – your ultimate guide
• How to protect and repair your gut while on antibiotics

 

 

References

1. Ely PH. Is psoriasis a bowel disease? Successful treatment with bile acids and bioflavonoids suggests it is. Clin Dermatol. 2018;36(3) 76–89.
2. Thye AYK, Bah YR, Law JWF, Tan LTH, He YW, Wong SH, et al. Gut-Skin Axis Unravelling the Connection between the Gut Microbiome and Psoriasis. Biomedicines. 2022 Apr 30;10(5) 1037.
3. Gyurcsovics K, Bertók L. Pathophysiology of psoriasis – coping endotoxins with bile acid therapy. Pathophysiology. 2003 Dec 1;10(1) 57–61.
4. Ungprasert P, Wijarnpreecha K, Kittanamongkolchai W. Psoriasis and Risk of Celiac Disease – A Systematic Review and Meta-analysis. Indian J Dermatol. 2017;62(1)41–6.
5. Perez-Bootello J, Berna-Rico E, Abbad-Jaime de Aragon C, Cova-Martin R, Goni L, Ballester-Martinez A, et al. Impact of the Mediterranean Diet on Patients With Psoriasis – Protocol for a Randomized Controlled Trial. JMIR Res Protoc. 2025 Jan 29;14 e64277.
6. Zhu J, He L. The Modulatory Effects of Curcumin on the Gut Microbiota – A Potential Strategy for Disease Treatment and Health Promotion. Microorganisms. 2024 Apr;12(4) 642.
7. Antiga E, Bonciolini V, Volpi W, Del Bianco E, Caproni M. Oral Curcumin (Meriva) Is Effective as an Adjuvant Treatment and Is Able to Reduce IL-22 Serum Levels in Patients with Psoriasis Vulgaris. BioMed Res Int. 2015;2015(1) 283634.
8. Vandeputte D, Falony G, Vieira-Silva S, Wang J, Sailer M, Theis S, et al. Prebiotic inulin-type fructans induce specific changes in the human gut microbiota. Gut. 2017 Nov 1;66(11) 1968–74.
9. Navarro-López V, Martínez-Andrés A, Ramírez-Boscá A, Ruzafa-Costas B, Núñez-Delegido E, Carrión-Gutiérrez MA, et al. Efficacy and Safety of Oral Administration of a Mixture of Probiotic Strains in Patients with Psoriasis – A Randomized Controlled Clinical Trial. Acta Derm Venereol. 2019 Nov 1;99(12) 1078–84.