0:00 Welcome to the Gutology podcast. This week, functional practitioner Julia Davies, as you all know her, sits down with nutritional therapist Emma Gold, who specializes in inflammatory skin issues like psoriasis. In today's episode, what exactly is psoriasis and why does it occur? What is the connection between your gut and your skin? Plus, Julia and Emma speak with listeners who have been battling these issues themselves. Let's dive in. Hi, Emma. Lovely to have you today. So um let's start at the beginning then. How did you how did you get into becoming a nutritional therapist and how did you get to specialize in psoriasis? So the two are really uh strongly linked. So I only retrained as a nutritionist. I graduated back in 2019 and it was my own experience with psoriasis that got me
0:46 into that. So um when I was about 32 after I had my first daughter and my daughter was a baby I started to get psoriasis patches on my elbows um which gradually kind of spread over my body over the next few years. Then when I had my son, I I started using steroid creams to kind of control it, which worked at first. And then when I got pregnant with my son, I didn't want to use the steroid creams because I was pregnant and I had quite a big flare then. I remember it being all over my forearms here and had started to go on my knees. And then when my son was born, so three years later, so I was about 33, um we were trying to move house and the house sale fell through and there's lots of stress, no sleep. I wasn't a nutritionist back then. I was living on caffeine and sugar and just trying to survive the days. Um
1:33 we were kind of um yeah the house sale didn't go through. So we ended up living with my parents for a bit and there was just lots up in the air and I was my skin was the worst it had ever been at that point. I was probably about 40 to 50% covered all over my thighs, still using the steroid creams but piling it on and it just wasn't having the same effects. Um, and it had got to the point where I'd gone down the light therapy route, but it was just a bit unmanageable with a baby and it was really hard to kind of to fathom. So, I started to research natural methods myself and came across a really uh popular book in the psoriasis community called Healing Psoriasis by a guy called Dr. Beano and he's written a book and he had really good experience with people changing their diet and their skin clearing. So, I kind of um it
2:20 was like a shining beacon. I just kind of held on to hope with this book and absolutely committed to it and stuck to this very strict elimination diet for about five or six months and my skin got worse worse and worse at first but I kept with it and then um I kind of grad I just turned a corner one day and suddenly my skin just completely cleared and within the space then of about 10 days I all my sis had gone. So uh my history is I've got a degree in human biology with psychology back from earlier on when I was kind of 18. So I knew that this wasn't just magic. So I wanted to know what what happened. So what was actually going on in my body for that to occur. So that's when I retrained as a nutritional therapist. So studied for three years. um and looked
3:05 into the gut skin link and all the different bodily systems and figured out what was going on in my body, why I had that um effects and why my sitis had cleared in the first place. So I imagine with everything that you've learned since um what's your view of like going back into that situation of things like what were the like the driving forces behind it? I imagine it's so easy now to see the bigger picture of what would you say that you've really picked up about yourself. So if someone was in that situation that you've just described, what can you tell them to kind of give them a heads up? Yeah. So it's so common that people just think it's all about eliminating the foods because and that did work for me and it works for many people, but subsequently um since qualifying I've done microbiome tests and blood tests and genetic tests. So
3:51 now I've actually gone back and I can work out why um my body had responded that way in the first place. And when I've done subsequent stool tests, I know that I have yeast overgrowths going on in my guts and gram negative bacteria and a couple of parasites. So all of these things were just in there creating toxins. Um, as I stopped eating the foods that fed them, they kind of died off, but as they died off temporarily, everything got more toxic. So that I see this often where people's skin gets worse before it gets better. So I know that's what was going on. I know now that I should have been supporting my liver a bit better because all those toxins end up going to the liver to be detoxified. So now with clients, I'd always really like support the liver to the max when that's going on. So yeah, I
4:38 suppose that was the root cause and the various genetics as well which which makes it all make sense. Before we go much further, should we just have a bit of a discussion about what psoriasis is as an autoimmune condition and you know how we would typically approach this kind of thing in clinic? So yeah, psoriasis is a chronic autoimmune condition. It affects about 125 million people I think is the latest research. So plaque psoriasis is the most common. About 80 to 90% of people have plaque psoriasis and it's basically where the skin turnover is too great. So you get kind of thickened plaques where it would normally be uh thin skin. Um some people get gutache psoriasis which is more linked with things like strep throat. Sometimes gutache can become plaque psoriasis. Then um afterwards people get it in their nails and in their scalp. Um
5:26 some people get inverse psoriasis which is in the the folds of the skin as well. Um but plaqueis is the most one and it's a thickening of the skin. Yeah. And then you know what's actually happening in the body then? So when we say it's an autoimmune condition, you know, what what's actually happening there with that, you know, how how does an autoimmune condition impact the skin and how, you know, so that's symptomatically really well described of, you know, what people suffer with. So you know, the leading up to it because that's really integral, isn't it, to how we work and how we approach it is trying to hack that process at different parts, figure out what's gone wrong, and then use that to not only clear the symptoms, but clear the autoimmune process that's then driving the symptoms. Yeah. I mean commonly people say autoimmunity is the body attacking itself which I don't know about you but I hate that phrase don't
6:12 agree our body does not attack itself so um instead it's just an overactive immune system so inflammatory cytoines and um parts in the body that are just overactive and you've got this um immune response and this immune cascade and some people are susceptible to it showing up as sasis um there's so many other autoimmune conditions for other people it would be other autoimmune conditions. Um but generally it does come down in in my experience something going on in the gut that's producing toxins that's crossing over a leaky gut and getting into the bloodstream and everything's getting fired up and the liver is having to detoxify and needing all of those things to be supported and in the right order as well. Yeah. Yeah.
6:59 I tend to see a lot of joint pain and inflammation along with psoriasis. Are you seeing that as well? Yeah. So, the seratic arthritis of course, which is really common. Um, so yeah, it's it's definitely linked and alongside it just uh kind of brain fog and fatigue and it's autoimmune. So, you're just not quite on par, waking up feeling tired um and affecting lots of different body systems. So, um getting back to your story then about the liver and you say you wish you'd supported your liver more. So let's kind of dig into why that might be helpful for somebody with psoriasis and why that's kind of an integral part of either the driving the symptoms or actually clearing up and recovering from it. Yeah. Um so to go back to that leaky gut theory and I suppose to my own experience so with the
7:46 the gram so let's look at the gram negative bacteria. So I had things like klebella and citroacta in my gut which produced a toxin called LPS lipopolyaccharide. Um, and these toxins cross over a leaky gut, which is also a bit of a mis, you know, um, I mean, all of our guts are supposed to be a bit leaky, aren't they? Like, we need to have gaps in that lining so that nutrients cross over into the bloodstream. But the problem happens when the gaps get too big and less flexible. So then we have things in the bloodstream that don't belong there. So not just nutrients, but things like LPS that cross over into the bloodstream. So in my case, I had LPS and other things, other toxins from the candida that were crossing over and activating this immune
8:34 system and then going to the liver to detoxify those. So um liver support and the different phases of of liver detoxification. I don't know how technical we're going to get, but trying to support all the different phases of of liver detoxification so that then the liver can package those into bile and get rid of them down the toilet. So without with LPS, I mean, it's so incredibly inflammatory, isn't it? They even use it in lab studies to induce inflammation in animal studies and things because its inflammatory property is so known and so predictable. So one of the things that we've got to look at is with the LPS that comes from the gram negative bacteria in the gut. There's sort of two aspects how I view this is how integral is that gut barrier because if that LPS remains in the gut it
9:20 doesn't cross into the bloodstream and then it won't have that inflammatory effect. But if the gut barrier is breached and you've got dispiosis in your microbiome then you've got a double whammy of an inflammatory hit. And so that from store testing um you know I'm I'm seeing that and um when we look at integrity of the the gut wall as well I always get super concerned really about somebody needing quite um thorough treatment quickly to actually help heal the gut barrier and then deal with the microbiome imbalances at the same time. What are you seeing similar? Yeah. Um I don't know particularly that secrettory IGA marker is that what you use to look at the so that's a marker of the mucosal lining that coats the whole of the GI
10:06 tract and where we've got this kind of leaky gut there's also that mucosal lining is just another barrier that stops things from crossing over. So often it's I seem either seem to see it one way or the other. It's either low or high and if it's high there's something activating it or if it's low it's just a sign that that mucosal lining is quite weak. Yeah. Yeah, I was just about to ask, are you seeing high or low? Because I'm seeing both as well. And I think sometimes low I find a bit more concerning because it's like a complete depletion and exhaustion of the immune system, isn't it? Whereas at least if it's high, the immune system still knows at that mucosal layer how to act and do its job. It's just reacting. So it's then a case of just gradually withdrawing those triggers once they're identified. Yeah. Yeah. Um and yeah, that mucosal lining is the first line of
10:52 defense really against anything coming in. Yeah. through the through into the body. Um and to build up we need things like vitamin A and vitamin D. Um immunog globulins I quite like to use as well. So to build to build up the strength of it really. So building up the immune system again. Why do you think people's mucosal lining in the gut is so under pressure? I wonder how much stress is linked to it. So stress is a really big factor. Yeah. whether I wonder how much of this and um goes back to digestion. So the digestion and the absorption of things like vitamin A and D which are both fats soluble vitamins. So there's a big kind of bile there was the study by Dr. Eli who looked at um bile acids with
11:38 psoriasis okay patients. So he gave ox bile to people with psoriasis and their skin got better. So is there a link there with boflow and bile emulsifies fats? So um if we're not breaking down the fats fully, we're not absorbing the fats soluble vitamins. So then if we're not absorbing our vitamin A and vitamin D, does the mucosal lining get weak because of that? In which case it goes back to um stress sometimes making sure we're less stressed so that when we eat we can digest the foods which then so then the bile is flowing better and then if the bile is flowing it means that we can absorb the vitamins that we need to make the mucosal lining. Yeah. And in my experience, people aren't eating enough fat at all. Are you finding that as well? Sometimes. Yeah. Um certainly not
12:26 enough healthy fats. Yeah. Exactly. Um and I always like to ask people about their bowel movements, of course, being a nutritionist, but whether their stalls seem sticky. So whether they're sticking to the toilet bowl after flushing, is there a layer of fat on the toilet water afterwards? Does it just look fatty? because our stools shouldn't be fatty. We should be absorbing all the fats in the body. Yeah. Um so that can be a really good indicator and then seeing if if the work that we do um around digestion and eating does that make the stores less fatty. So how could we just you know give kind of a couple of tips to how to really support the gallbladder and the bile injection? Yeah. Yeah. What would you do? Um bitters. I love bitters. Me too.
13:12 Me too. Yeah. say bitter foods. So things like rocket, water crest, um radish about 15 to 30 minutes before a meal, um and anything bitter that kind of makes you go a little bit just kickstarting the digestive system. What's kind of talk through like your kind of top one or two things of holistic management of psoriasis and what you do in practice and the areas that you feel, you know, really worth considering if you've got psoriasis. Yeah. So, uh, we touched a bit on stress. I think of stress as the umbrella that just is over everything. Yeah. And there's reasons for it now. So, if we're trying to eat when we're stressed, you can't digest food well if you're in sympathetic, if your nervous system is in sympathetic state. So, at
13:57 least trying to be relaxed when you're eating. So, the mindful eating practices. So, just dropping your shoulders, unclenching your jaw, um, chewing really well, and just switching on that digestive system. and bitters do the same for that. Um, less stress is less cortisol, so less inflammation in the body as well. Um, as we've spoke about, stress uh can degrade that mucosal lining. So, trying to yeah, trying to always get on top of stress somehow. And I think it's consistency. Something consistent every day length of time is not so important. I love Epsom salt baths foris. Me too. Yeah. So, um, and that's kind of multifaceted, so it's
14:42 nice. It's relaxing because you're in a lovely warm bath. You've got the salts, um, which soften the skin, but also you're absorbing the magnesium through the skin. So, the magnesium is nature's tranquilizer, and the magnesium sulfate part helps with the liver sulfation pathway as well. So, yeah, the sulfur, I think, is really crucial, isn't it, for psoriasis. It's a really important nutrient. Absolutely. M um so yeah getting on top of the stress thing I think is really important. Good. Good. So with the cortisol then let's just dig into that for a minute because it's because cortisol is anti-inflammatory isn't it? But it becomes inflammatory when it's disregulated. So it's a it's a quite a lot of nuance there isn't there because cortisol usually is like our body's internal anti-inflammatory. But then of course when you are
15:29 constantly stressed and constantly wired and overworked and all of those kind of things that modern living entails it's too much prolonged cortisol secretion and that your cells start to become quite resistant to it, don't they? And then eventually it can actually cause inflammation rather than reduce inflammation. Yeah, cortisol should have this lovely graph, shouldn't it? So there's a boost when we first wake up in the morning which gets us out of bed and then gradually gradually decrease until we go to bed and it should look like that but um it's often isn't I think for nowadays and people can test for it although I think with all tests we have to ask does it change what we're going to do afterwards um and really we should all be working on our parasympathetic nervous system anyway but sometime it can even flatline sometimes and there's
16:15 not even if people struggle to get out of bed in the morning it could even flatline Um, so yeah, like you say, trying to get it in balance, I think. Yeah, it's helpful for the gut and the diet, I think, to look at cortisol patterns because when that cortisol does spike high, as you say, in the morning, that's a really good time to get your metabolism going and all of your your um your hormones going for optimal digestion. So, a lot of people tend to sort of eat later and then later into the evening when actually the cortisol is lower and so the rest of the digestive hormones and um everything that makes you feel full and like your insulin sensitivity it's all dropping but that's when most people are eating the majority of their calories. So one thing that we do is kind of switch it so that people have like a heavier lunch
17:00 main meal or breakfast because that's when the cortisol is more active and then it can actually allow things in the digestion to run much more smoothly. So it's one of the interventions we do with psoriasis is intermittent fasting. Is that something that you're doing as well? I would do um across the board try and do 12 hours overnight. Yeah. But anything more it it's individual really I think. Um, so it can make things worse if you're somebody who's already stressed, I think. And if you start start skipping meals here and there, it can yeah, not necessarily be a good thing. Okay. Um, so it depends on the individual, I think. But generally 12 hours overnight. I like your idea of Yeah. breakfast like a king. And um, and I think a high a good high protein breakfast, you just start the day just balanced. Everything's balanced, your
17:46 hormones, your blood sugars, and you're just kind of topping up. So top up a bit at lunchtime and you're still stable. top up a bit more at dinner and like that's your day gone. Whereas starting the day with, you know, sugary cereal, it's just starting that blood sugar roller coaster. So, I mean, there's quite a link, I think, between insulin sensitivity and psoriasis in terms of getting the blood sugar balance. That's something that I found really helpful in psoriasis cases is like maybe using a a continuous glucose monitor and seeing what their responses are like because it's quite hard to pick up actually somebody's insulin sensitivity. It's like a few a few clues like if they're getting like you know if they're collecting fat around the middle that can sometimes be a key to insulin
18:32 sensitivity. But it doesn't because of those metabolic changes it takes a while for it to show up in blood tests. So if you you know test your blood sugar and it looks bang on but actually how much insulin is needed to keep it in that range and also the marker of your red blood cells with HBA1C you know when that starts to to rise and change because the blood cells have got too much sugar attached to them that's then the mechanism quite broken really. So, one of the areas that I look at is much more in the insulin sensitivity bit and see if we can really optimize that because there seems to be a huge correlation with with insulin resistance and psoriasis in the skin. Okay. Yeah. It's not something I've particularly kind of specifically picked up on, but yeah, generally, yeah, there's lots of
19:17 people with insulin, myself included. So, I had gestational diabetes. Oh, wow. So, that's an interesting correlation there, isn't it? Yeah. Yeah. And then um so sometimes it goes back to the so I always like to make sure people are having enough protein. Yeah. So that's a really good way to balance blood sugar. Also, yeah, to balance all of our hormones in the body as well. Um and can help to keep blood sugar levels stable. So again, like starting that day with a really good high protein breakfast kind of has all the effects. Just a reminder, you can actually call in to the Gutology podcast. Make sure you're following us on Instagram to find out who our next guest will be. They might just be able to help you. All right, let's get to the callers. I've really uh scrubbed the room that I'm staying in from top to
20:04 bottom um to remove any dust mites or dust and um and I've started like changing my sheets really regularly and washing everything um and just yeah, washing the walls, you know, doing that. And it does seem to be helping with some of the inflammation. Okay. But it will just flare up for I I have no idea why. Um can't really get a sense of what causes it. Seems to be related to stress, but it doesn't seem to be just related to stress. And you mentioned also that the cold and the sun and the wind affect it as well. So does the cold help it or worsen it? Cold seems to make it worse. Ah, okay. Okay. And how about the sun? the the sun can if it's up, you know, it's it's like
20:51 it's just very tender. Um so the sun can but also it feels like a little bit of the sun seems to help but not too much. Yeah. And I have been putting um like a a natural cream oil like a a very gentle biodnamic actually cream at night and that seems to help as well. the sunshine. It's very interesting because you know obviously light therapy is something that is used as a treatment for psoriasis but then with the sun um it's trying to kind of regain a really natural rhythm with the sun can be really helpful. So what we found is is going out at sunrise or close to
21:37 which is really easy right now cuz sunrise is about4 to 7. Um you get a lot of red light frequencies at that time and that's really soothing to the skin and the more potent UV light comes in the middle part of the day. So if you're getting out first thing in the morning, it's really soothing to the skin and it can actually even help your sensitivity to the sun. So people that, you know, even get hives in the sun or skin reactions when they're in the in the light, it can really help rebuild a resilience against that again. So it's um might be a really really nice habit for you to do on a daily basis to actually get out at sunrise now for, you know, the next few months and just see if you can notice a difference. And one
22:22 thing that that does is it really helps with your circadian rhythm, which is to do with your body clock. And what's really interesting about psoriasis is it is a condition that is really impacted when your body clock goes out of sync. Oh, no way. And I've had I've had some insomnia. Oh, that is interesting. Yeah. Seem to affect that. Oh, interesting. Yeah. You know, if you think of this, you know, the everything's on a rhythm in the body, isn't it? So, the way that your skin cells grow and replicate, that's all on a rhythm and it's massively sped up in psoriasis. and the layers of skin that were normal has sort of all lost their organization and that's what causes the plaques in psoriasis. So if you can regain a rhythm at the skin level, one of the best ways to do that is regain the circadian
23:07 rhythm of your whole body in your brain. And that's most responsive to light. So the the sunrise um is going to do more for you I would say than just you know dealing with the light as a trigger for you and actually start to heal the skin. But one that rhythmical pattern as well, it really helps reduce the inflammation in the skin. Oh, that's amazing. I'm I'm actually also nomadic. So, every two or three months I move. Okay. So, that is this is going to be really helpful because I could get the sunrise wherever whatever times I follow the sunrise. I love that. Yeah, definitely. That's cool. And it might really help the insomnia then. I'd be fascinated to to hear if it actually really helps settle the sleep because that's one of the hardest things to work
23:53 out. But when people get really aligned to a circadian rhythm, it really does work. It really does. It's it's like we're all we're meant to be on these cycles, our entire bodies. So, it's just reconnecting with that really. And also, is it also useful to do it? I heard this, but I don't know if it's true to go out at night. Yeah, sunset is again a really soothing time I think for for setting your brain circadian rhythm. It's really responsive like the power time is definitely within two hours of sunrise in the morning. But it's really it's equally soothing for your skin um and for inflammation to go out and a couple of hours before sunrise sorry sunset and at sunset itself. So I think it's just gradually then you know building up to going out in the middle of the day because then you will get
24:40 more tolerance to that. I know you're nomadic. I wonder if you have access to a bath. A really brilliant thing to team with sunlight is also Epsom salt baths the other end of the day. So before bed. Okay. Yeah. I don't at the moment but I whenever I get anywhere near a bath I go for Epsom salt bath. I didn't know at night that night time bath before sleep. Yeah, that would be amazing to do. Um I like to try and get people to do seven nights of baths in a row. So to use quite a lot, about a kilogram of Epsom salts per bath to stay in between about 30 and 60 minutes. Um and to make sure the Epsom salts contain magnesium sulfate and the sulfate part of the magnesium sulfate helps with a process called sulfation in
25:25 the body. and sunlight also helps sulfation. So, it's kind of a kind of a two-pronged approach. Um, and helps might help with your insomnia as well. Um, I don't know if you're close to flotation tanks sometimes. I haven't been in one for years, but yeah, I'd love to. Yeah, if someone doesn't have a bathtub or even, to be honest, a foot bath soak. So, just use less. Use about 250 grams of Epsom salts. Um, you can use a washing up bowl and just um use the Epsom salts in the in there and put your feet in and at least then you're soaking in the magnesium sulfate through the feet. You could even rub it on where abouts on your body is it? It's on my uh mainly over my right eye, forehead. Oh,
26:11 okay. So, um yeah, obviously you don't want to get the salts in that area. if it was elsewhere on the body, you could maybe think about putting the Epsom salts in that area as well. But I think it would still help um kind of systemically just by absorbing that magnesium sulfate as well. Um you mentioned about stopping sugar and chocolate. Is this a bit of an issue for you? Yeah. I mean, not I mean, not comparatively. I I listened to your broadcast years ago and I'd already been eating pretty healthily, but I pretty much do everything that you suggested and um it's wonderful. But I um yeah, I really enjoy uh sweet things and I'm I'm kind of like really pretty much stopping. Okay. The chocolate's hard.
26:56 Yeah, it's tough. I mean, it can be a real addiction, can't it? Even if you've got a really good mindset, your body is sort of screaming out it wants sugar. So, but you know, you do get a lot of microbiome changes when you cut out sugar and you really do eliminate it. And so, I I would say about two to three weeks and you actually stop craving it, it gets a lot easier. Um, and also just focus on the protein. I'm a bit like a stuck record with protein, but it's just so important. But it just helps to stabilize blood sugar levels and it just protein satiates us. So it doesn't feel restrictive. It's it's a good way to stabilize the body to fill us up. Um and to focus on getting enough protein each day is feels kind of healthy rather than thinking about all the things that you can't have instead have enough protein.
27:43 Um so yeah. Can I ask a quick question about that? Well, two things. One, um I still have sourdough bread. I make sourdough bread. So, I don't know if that would count as sugars or is that like a healthy carb? Everyone's got a different tolerance. I don't know if you would see that in clinic as well, Emma. But, um, some So, I think the I think the most important thing is to get the refined sugar out like the cakes, the biscuits, the sort of, you know, sugary drinks, things like that. That's a no-brainer. But I think and as it goes deeper, it does depend on your own chemistry of how you handle carbohydrate foods. So, some people just handle them really nicely and it doesn't seem to contribute to inflammation and it supports the microbiome really well. Other people can't really tolerate um
28:30 carbohydrate very well at all. It causes insulin spikes and then inflammation in the skin and can worsen psoriasis. So, I think it's more an I I would focus on the on the clear refined sugar stuff first and see how you get on, but then if you you may need to go a little bit further with that and just how you handle your dietary carbohydrate that are even from healthy foods and team it with um protein and fats. So, if you can have a couple of eggs on it and some kind of some nice butter or some olive oil or avocado um that should help as well. And I ideally are gluten-free. I don't know how you feel about gluten-free, Julia, but I with anything autoimmune. And I don't like restricting foods, but gluten is just the one that's kind of got the research behind it with the the link
29:17 with the intestinal permeability. If it's an easy enough swap just to do make your own gluten-free sourdough instead, that might be a good idea as well. Yeah, I totally wholeheartedly agree with that. I've seen gluten um in most people um uh have it's an aggravating thing for the gut and for the condition. I think the only thing to watch is gluten-free replacement. So, if you are making your own, fantastic. But if you're in the supermarket looking for gluten-free options, it's not really great. Um certainly taste is not good, but you just got to look at the labels and read the ingredients to know that these are not healthy foods. So, I think yes, I would absolutely recommend um removing gluten from the diet as best you as you can, but don't fall into the trap of alternatives because you'll probably make yourself worse from an inflammatory
30:02 perspective even though you've eliminated gluten. And thank you. And in terms of the proteins, I just want to quickly mention it because I generally don't eat meat. I will do occasionally, but I usually eat fish and um unpasteurized cheese. I can't do pasteurized yogurt, kafir, that sort of thing. Eggs. Lots of eggs. Is that enough to get my protein? Yeah, I'd add in maybe legumes. Are you having like chickpeas, lentils, butter beans? Yeah, we have a lot of I have legumes every day actually. Yeah. Yeah. Um things like quinoa can be useful. Nuts and seeds. Yeah, you might. So, um kind of from a quantitative point of view about 100 gram 80 to 100 grams a day. A bit depends on how much you weigh. So, a
30:48 bare minimum is about 0.8. 8 g per kilogram of body weight. But if you're doing any kind of exercise, you can almost double it really. So kind of 1.6 1.8 grams per kilogram. Uh when the psoriasis the skin because the skin's turning over quicker, we need more protein for that as well because our body's using more. Um so yeah, it might be worth measuring it for a few days just to get an idea of, you know, there's about eight grams of protein in an egg. Just trying to figure out how much protein is in things. You could maybe add things like tempeh. Um Yeah. Kind of fermented soy, which is a good source as well. Yeah. I really like a bread called lifechanging bread. Do you know that one, Julia? Oh, yeah. Life changing. Yeah. That's got nuts and seeds in it. So, that's really high
31:34 protein and high fat. Um to have alongside things like soups. Wonderful. Okay. Oh, thank you so much. You've been so helpful. I'm really grateful. Oh, good. Good. Well, there setting foundations really, isn't it? And I think just allowing your body to unfold in the way it it knows how to do when you sort of just tweak a few things in your in your lifestyle. I've always had a bit of psoriasis on my leg for a large chunk of my life. Um, but the last two to three years, um, it's really flared up to a point where it's a bit like whack-a-ole. You don't know where the next patch is going to grow. Um I'm trying I'm on the sort of a journey with medication for the first time. So it's always been steroid cranes of all sorts
32:20 of variants treating sort of localized localized patches around me. Um but now I'm on um uh I've started a course of acetin and sort of fingers crossed that hopefully that that might give me some rest bite or at least slow down or give me some sort of hope that you know we're on to something onto something positive to to help settle down the the psoriasis. But um yeah, so as well as being sort of lower legs, I've got coverage, you know, both quads, my back, my torso, back of my hands. And this is when you know, back of the hands, especially when it starts to get more visible, and that's when it becomes really concerning. So, you know, I've got a couple of patch I'm bald, so a couple of patches on my scalp have started to appear. Um, so yeah, that's
33:10 very concerning because it's super visible because I don't want to be uh a lifelong a person lifelong medication. Um, I think there's something that I want, you know, I think there's something out there that could perhaps help me um do things differently that will help my general well-being, but also, you know, help me resolve the the problem I've got in my psoriasis. I think that's a really good way to look at it as optimizing the skin as a reflection of what's going on inside the body. So when everything's balanced inside the body, it reflects on the skin. So I think that yeah, what you're doing is great to kind of do those investigations and to look where any imbalances might be and to look at it as just as a way of living optimally and living to our best um the best that we can every day and almost as a byproduct
33:57 the skin gets better. I don't know if you find the same Julie. I do find that the more people focus on the skin, it can create stress in itself um and it can get to a point where people are so desperately want to clear the skin, which is understandable because it's you kind of mentioned the psychological effects there a little bit as well. But um it a fine balance between um focusing on the skin and clearing it but not getting too fixated so that it's stressful and then the stress in itself creates more psoriasis. So almost it helps just to focus on um optimizing our body to live well and the psoriasis kind of fades that way. Yeah, I cut out gluten completely. Um I cut out dairy completely. I have tried that for a period of 3 months. I don't know
34:43 whether given the severity of myis at the time was whether 3 months was enough or maybe I should you know persevered a little bit longer but you know if you start to see a glimmer of progress then you stick with it. But I wasn't seeing it. I was just like, you know, I think I'm not getting anywhere with this. There's there's something else. And that would be my thought as well that there's something else going on inside the body. And I think food gets the blame a lot. So people go on very strict elimination diets. And it does work. As we were talking earlier, it helped when I was clearing my skin. But it wasn't the fault of the food. It was the fact that there are imbalances going on inside the body. And by kind of not providing the food to make those imbalances worse, that's when the skin gets better. But a kind of a different way of looking at it is to find out what those imbalances
35:29 are. And luckily we've got the technology now that we can do that and directly address the imbalances and then food becomes less important that way around. So for some people giving up gluten and dairy can just help, but is it really getting to the root cause of what's going on otherwise inside the body? Um, so sometimes that's when further investigations can just help and then address those imbalances and still be able to have a wide range of foods. Last couple years has been quite really full on for me. Right, from a a lifestyle perspective, I've got a I've got a full-on job as it is. I'm studying outside of work. Uh, I've taken up marathon training, so I've done quite a bit of that. people around me if they just say, "Look, it's you perhaps taken on too much and it's it's the skin
36:16 that's been that's kind of paying the price for that of being really tired a lot of the time." Um, but these are things that I enjoy. So, I'm very sort of reluctant to to dial it down. So, I'm hoping it's something that um, you know, through the correct dietary changes might help me support me in some of the things that I want to do and not and not let psoriasis be a barrier for the things that I I want to do if you see what I mean. Don't want to be defined by it. There's lots of different approaches to support that actually. So like you know with the diet, you know, we can get an anti-inflammatory effect to a point, but if you're not really seeing a lot of change with that, it's sort of meaning
37:01 that we've not nailed the real trigger. But, you know, for a lot of people, stress is a real significantly driving force behind psoriasis. So we can use something called adaptogens. That's what we use in clinic. And it's like it's different types of um supplement approaches and herbs to actually help support the stress resilience in your body. So that when exercise in itself, although you enjoy it, might actually be adding to your stress load. um particularly with marathons and things like that, you know, when it's quite extreme, there's ways in which you can actually support the body to step up to it and but not not let it. It's kind of breaking the cycle of how that stress then causes inflammation. There's there's pathways you can intervene
37:47 within the body to actually protect you a little bit more than perhaps you are at the moment. So it's not a case of, you know, everyone's so different, but it's not a case of stop everything you love doing that relaxes you and in order to let yourself rest so your psoriasis will clear up. I think it's just trying to really identify is that is that a factor or actually isn't it? It might not be, but if it is, then supporting your body to step up to it rather than just sort of do you know do I or don't I kind of option. Um, yeah, I completely agree. It's meeting yourself where you are. So psoriasis is bad enough as it is as you kind of touched upon. You don't want it to stop you doing anything in life. So it's just this is the reality of where you are. You're studying at the moment. You're enjoying marathons and all that's great. So we'll just do all
38:34 we can to support your body where you are at this moment with and then sometimes it's about pulling out the stops with managing the stress load. So with things like adaptogens or just other ways to um to activate your parasympathetic nervous system. So, deep belly breathing, um, activating the vagus nerve, um, tapping kind of on your chest here is a way to activate the vagus nerve, gargling, humming, singing, cold water therapy, and all those things to add in alongside so that we're supporting your body through that time. Um, because that's where you are at the moment. Take me back to when you say your first flare up was during lockdown. Um, can you remember was that actually around when you had an infection of COVID or was it
39:21 around a change of circumstance or like can you just share a bit more about your experience around there because that might give us a huge clue as to why it's gotten so bad in your body. Um, so that first flare up I I didn't catch COVID in in first lockdown. Yeah. Quite thankfully. Um, I think it was it was a flare up that sort of lasted for about 3 to 6 months and then kind of died away. So, when I say flare up, it went to one shin to two shins to both arms. Yeah. Um, and then it kind of sort of subsided. You could still see um the remains of the patches if you see what I mean. So it's like kind of kind of stained the skin for one of a better phrase. Um so that kind of sorted itself
40:09 out. Um I think the most recent episode was probably from the end of 2022. So beginning of 2023 um was when it started to gradually get worse and again that kind of coincided with me starting the studying starting the running. So it's direct isn't it? That's your proof, isn't it? Really? Yeah, you can see that. But then also I think um what I think sorry now that I'm talking about it at the beginning of last year I had um my legs is my shins are always particularly the most itchy more than anywhere else and I would scratch and scratch and scratch and um my legs looked like that they got quite infected. So go to the GP natural
40:55 reaction was to give me strong antibiotics. Yeah. And I think that probably made the and that now that I think about it that coincided with me cutting out the gluten, cutting out the dairy and I think the strong antibiotics kind of countered the uh positive steps that I was doing with my diet. So hence I wasn't seeing the benefit and actually um that was just before I was going in for some light therapy treatment. Um I'd seen someone who prescribed um um Installar and that kind of you know that subsidi that completely subsided the inflammation of my legs within a few days. So it wasn't an infection is just sort of the excessive scratching that
41:40 caused it to to sort of flare up and it needed to calm down a bit. So I'm guessing I don't know if without those antibiotics I might have been in a better position with the dietary changes. Who knows? It's tricky to extrapolate it all, isn't it? I think what's interesting with the stress aspect is, you know, it's it's clearly coincided with when you were studying and started that, but what would be really interesting to discover along the way is how exactly is that stress causing the inflammation in the skin? So is it because it's withdrawing blood supply and energy from the gut and the microbiome is falling um you know falling victim to that and is it a microbiome change that's then becoming really inflammatory or is it
42:27 that stress chronically is really suppressive of your immune system generally. So you've maybe got other things that your immune systems um uh fighting and that is causing the inflammation in the skin. like there's so many different like exact mechanisms that h happen to your biology when you're in distress. It would be really interesting to find out which which it is for you because and that can be discovered through functional testing of course. Um, and then you kind of know what you're working with in a way so that when you do go, you know, you're sort of getting on with your life and studying and working and, you know, doing all of these things. You've got a greater awareness of how to hack into that. So that it's still it's not actually it's not actually damaging you as it seems to be at the moment. So it's
43:12 like shortterm and long-term tactics and interventions that could really support you. But I think probably you're quite clear on what the triggers are now. I think the job is to work out how does that then translate to the skin and then intervene in that in that pathway really. Yeah. And the other um the other big one I always think of with stress is the digestion. So whether uh stress means that you're producing less stomach acids which then means even if you're eating the healthiest diet in the world if the stomach acid is low it's harder to digest that that food and absorb all the nutrients. And then we can quite quickly get into a state where we're nutritionally depleted. And of course, we need all the nutrients for everything in the body. And there's a big kind of protein psoriasis link as well. So, we
43:58 need that stomach acid to actually be breaking down the protein so that we're using those amino acids for everything, but also importantly for liver um detoxification pathways. So, we need amino acids for that. So, that's something powerful that you could do right now really like focus on the at least feeling relaxed when you're eating. Um, and if you can punctuate your day with three meals, you know, three times a day when you're relaxed when you're eating and at least you're starting to build up your nutritional status that way. So, really chewing really well, um, taking six deep breaths before eating and yeah, using that as a way to get into parasympathetic states. I think the other thing is um, you know, thinking about it as well was prior to 2022, I
44:44 went on a big weight loss journey. that I lost quite a bit of weight. I kind of got into a cycle is of because I'm no I'm going to burn the calories. I kided myself into thinking that I keep eat what I want because I'm going to run burn. Yeah. So then I've got a very bad very bad sweet tooth and I think that not fueling myself correctly probably uh not helped. Um but you know excessive sugar we all know also doesn't help you either. So, I'm I'm kind of guessing that could have something to do with it. Do you know what I mean? So, it's it's got a huge huge amount to do with it. But, that's also really great information because that's like sugar is like a bit of a lowhanging fruit when you're trying to manage psoriasis and getting your blood sugars really nice and stable will have
45:31 such a positive impact on the skin. And so, you know, that could the stress involvement could even be spiking your blood sugar in the absence of food. So, you've got a double whammy. you know when you getting stressed or you're doing too much exercise and your blood sugar is too high or too low and it's kind of rocketing a bit but then also your diet was supporting that as well then that is a bit of a double whammy on the metabolic side of things but that is it's I actually really like it when people say can identify these things because they're all really potent in healing from psoriasis. So, the fact that you've kind of nailed two or three really significant factors that you know you you know without a doubt that they are going to help improve your skin. Currently, I'm I'm kind of holding the the the symptoms um by sticking to a
46:19 strict uh low diet in in salif. Yeah. But but but it's it's been going on for a long time. And have you had complete uh remission by doing that diet in the past? Well, yes. I mean, you know, I've managed to eradicate the the problem in the sense that, you know, it doesn't bother me and you can't see it. Can you describe for us the the foods that you eliminated in if if it's not too many of them just so that we can get a really a real grasp of what you did because sometimes it can be other mechanisms as well. It might be helpful to know exactly what you cut out. Oh, well, it's it's very strict. Um, I say I I took uh I took advice from a uh a nutritionist
47:04 on this and um so all fruits except pears and mangoes. Yeah. Um pretty much all vegetables uh except um I do celery, iceberg, lettuce. um you know, but that's pretty much it. Uh then I tend to go with um you know, meat and fish, but instead of instead of sort of frying it or baking it, I I put it in a in a pan with a little bit of water. Uh so as not to make it too tasty. It's basically extremely bland food. That's what it is. Rice, white rice instead of brown rice, peeled potatoes. And at the same time, were you
47:49 also cutting out like sugary foods and drinks or anything like that? Did you make any other dietary changes? Yeah. Yeah, I' I've I've I've cut out all that. I mean, I I I don't do sugar anymore anyway, the raw sugar. Yeah. Um caffeine has been a bit of a problem for me, but I I have been caffeine free for the last couple of months, probably for longer than uh than I have been for years. And is that helped your skin at all to be caffeine free? Is there any correlation? Well, I I I can't tell because I've done, you know, I've done too many things at once, I guess. But, um, maybe maybe that's a possibility. So, the last couple of months, have you been on a restricted diet as well, then? Yeah. Yeah, I see. I see. Yeah, it is difficult, isn't it? I I I I suppose uh
48:37 caffeine has been a bit of a crutch for me all all my life. I've been a big tea tea drinker, so the last couple of months have been quite uh quite difficult. Yeah, it's it's very interesting that your response really um to the restrictive diet because yeah, it is very restrictive but a lot of people actually can respond to this kind of eating where it's like really stripped back and it's less less veg because a lot of plant foods although there's lots of benefits for plant foods for our our health, our immunity, our microbiome, but also when your immune system's not not tolerating them, you know, plant foods do actually naturally just for their own existence and survival produce some compounds that are quite toxic. So there's phitates, there's oxalates, you
49:23 know, all these things and that I'm sure you now know about, but an elimination of those things can sometimes be really helpful for all inflammatory conditions. So, um, I think you're certainly not alone in having that. So, I think it's really taking it to the next step and really then discovering what is it that's stressing your immune system that you can't really tolerate these things or you can to a point but then it kind of keeps recurring and you've got to then do that full elimination again. Have you got any gut issues that you're aware of? Uh uh when you say gut, what do you mean? You mean gut? So, like anything really. So, anything that springs to mind from like do you have a problem swallowing? Any like any any sensation above your belly button with like acid feeling, reflux, indigestion or No, I I I got nothing that I can I
50:09 could Okay. report on that. No, that's good. And then below the belly button, any any sort of bloating where you feel like your trousers are tightening throughout the day or any gassiness or pains or just anything that's discomfort? Nothing at all. Nothing like that. No. And are you opening your bowels on a daily basis? Yes. Okay. So, that all sounds really encouraging actually encouraging definitely that things are working. Well, I I would say that having having the last couple of months have certainly uh you know made that better. Yeah. Yeah. Okay. Um you had a glucose tolerance test at some point. Was that a long time ago or was that more recent? That's I probably over 30 years ago now.
50:55 Yeah. Criy. Okay. And how's your blood sugar doing these days? Do you is that something that you're much better? I mean, I I would say that that, you know, that that nipped that problem uh in in in the bud. It's just that jolly good. Um, you know, I never I suppose having I I simply never returned to the same level of energy that I used to have uh as uh when I was consuming probably far too much sugar. When you had, again, I think this is going back into your history more than anything, but when you had antihistamines for your skin problem, did they help or did they make no difference? Well, I don't think they did. Uh, but you know, it's it's diff difficult to to measure. I I I I don't think they made much of it. Possibly they did a minor difference, but I I
51:41 don't really have a good handle on that. I think it would be good uh to explore maybe your reaction to histamines. So along with the foods that you mentioned um being high in salicellates um there can also be some of those foods which are high in histamine and histamine is like a bucket in our body. Um so we need some histamine for everything to be working well. But sometimes that bucket can quite quickly get full. When it overflows is when we get symptoms. So symptoms might be itching on the skin or hay fever. Some people might get headaches. Um hives. Do you get anything like that? Do you get headaches or hives? Yes. I think hives. I think I think that's it. Yeah. Yeah. Okay. So it does feel like maybe your histamine bucket is getting a bit too full and
52:28 maybe it's overflowing which is giving you the symptoms. Um, whenever I address a histamine issue, the last thing I like to do is to look at foods. So, firstly, there may be other things that are going on inside the body that are filling up that histamine bucket. So, you may have um fairly high levels of histamine producing bacteria in the gut. You may have um something like candida, like a yeast overgrowth, which can contribute to high histamine in the body, too. Um I think I did a test of that many, many years ago, but I'm probably due for another one. Yeah. Okay. Well, a candida um did you do like a microbiome test? So, all of these things could be filling up the bucket kind of through no fault of our own and then the last thing to go in which is the high histamine foods just tips it over. So, kind of a more
53:14 sustainable way to look at it is instead to to work on the inside. So, to rebalance the gut, reduce down any levels of candida or high histamine producing bacteria. Um, and the third thing, what what what what sort of foods give give give high are high in histamine? Um, high histamine foods. Again, it's always the least preferred option in in my opinion to take them out unless there's a real high histamine thing going on. But it can be um like tomatoes because they're so nutritious otherwise. So, it's a real I find it a real shame to cut out any foods if you don't have to. But yeah, things like tomatoes, um avocado, for example, spinach, anything leftover can produce histamine. Right. Um, so the interesting thing about salicellates that you mentioned is that salicellates in
53:59 themselves can inhibit something called DAO in the body. DAO is an enzyme that breaks down histamine. Um, genetically some people don't make DAO as well as others. So there could be an issue going on there. We also need certain nutrients to make sure that you're producing enough DAO. So rather than the fault being the salicellates, it's kind of the deeper issue would be to look at what's going on inside the body that maybe they're um inhibiting DAO. Histamine is produced by our MAR cells in the body and salicellates can also trigger the MAR cells to produce histamine. So maybe there's a bit of an issue there. But I think the first step to go down ideally would be to look at what's going on in the gut and is there something there that can be lowered to stop potentially
54:47 things in there producing histamine and filling up that bucket anyway. So with the ultimate aim to be the fact that you can eat a whole range of foods because that's um the best way to live really. Life is a bit boring if we're just cutting out foods and um going on these continual um elimination diets. But it would make sense in that case why it does help your skin eating that way. Yes. But but c can you explain why? So I mean you know from time to time I've gone this diet but normally it's it's really quite effective in in solving the problem and normally for quite some time you know it might be a year or 18 months before I go into problems but but this time it just doesn't seem to be working. Is there anything else going on? Is it hay fever season? Are you stressed at
55:32 the moment? Oh no. Well, no, it's not. Well, well, it is Hait season, but I you know, you know, I I have eradicated my HV. I think it's looking at the total load of what's going on for you right now. And it's I would say that for um it's a common situation where people can manage it to a degree and then it starts to fail and then that's kind of where they seek professional help with us. So, I think that in that situation I just often look at what is the total load of everything coming on in your life. So, it can sometimes be um stress, relationships, work issues, stuff like that that kind of it like lowers your threshold. So, um you mentioned um a few minutes ago about it being like a threshold issue and you sort of lose tolerance at a certain point when the conditions are right. So, it's actually understanding you you're
56:19 definitely really firm on the dietary aspect of it and what you need to do to kind of bring you back from the edge of the cliff, but now there's something else that's at play that we don't know about. And I think the key to it is finding out what else is at play, which is meaning that that diet is no longer taking the effectiveness that it has had in the past. So, you know, it can just be sometimes like buildup of other conditions in the body. Um, it can be to do with the gut function, can be to do with how the liver is processing these things as well because the liver is a really hard worker in the body. And sometimes if you know if you are under stress or you've got things going on and it your tolerance of your dietary um proteins and things can become a little bit on the back foot. So I think it's it's looking outside of the diet I think
57:05 would be really potent for you to just figure out what else might be contributing to this situation. And the one thing that I'm going to mention that is a less obvious thing but I found has a real impact is what you're inhaling. So what is your immediate environment like? You know, do you have um toxins being produced left, right, and center in your home? Like from lots of cleaning chemicals that have got synthetic fragrances, washing powders, candles, plug-in air fresheners, like you know, things like that. And what's then is there pollution in your street where you are? Do you do a lot of walking on busy roads? Is there any damp or mold issue in the house? Like there's lots of different things, but I would always look when somebody sort of has
57:50 that threshold situation. What is it that as Emma described as a bucket, what is it that's filling that bucket up and can we identify those things? I'd also just yeah wonder what your nutritional status is like. Um, so we mentioned a bit about the DAIO enzyme that breaks down histamine. We need particularly the B vitamins to help to break down to make the DAO enzyme to break down the histamine. So they're particularly in green leafy vegetables. So if you've cut those out a lot on and off over the years, um it's maybe looking at that and kind of what your nutritional status of that might be. B vitamins are also in meats. So I'm glad that you're eating meat, but maybe make sure that you're digesting the meat and absorbing it well enough to get the B vitamins out of that meat. But that might be another kind of
58:36 avenue to think about. Okay, those uh those calls were all very interesting to get a real insight into what people are dealing with. Um, so with diet then let's just have a a quick debrief about that and how sometimes it's just not it's not always the key issue is it? No. And it's so common and it's it's horrible having psoriasis. We haven't really spoken about the mental effects much but it really takes over your day-to-day life to the point where you don't want to wear short sleeves in the summer. You don't want to reveal your skin. You don't want to go swimming. Um, and people do look for their own ways to manage it which is amazing. But I think a quick Google search often comes up with these really strict elimination diets and then it creates unhealthy habits around food a lot. So from my own experience just I would not budge from
59:21 that very strict elimination diet and that's not what life's about. Like we've still got to live alongside um this skin thing. So I think um a lot of the clients that I see in clinic are coming to me already on a very strict elimination diet and for whatever reason it stops working or they just want to dig a little bit deeper. And that's when I think the further investigations to see what's going on in the body that it's not the fault of the food. Um, even if someone's eating sugar, more than likely there's maybe a fungal issue going on in the gut and the sugar is feeding the yeast and the yeast is producing toxins and the toxins are crossing over the leaky gut and activating the immune system and overworking the liver and there we've got psoriasis. So, of course, we don't want to tell everyone to go and eat loads of sugar, but it's more about kind
1:00:08 of dumbing down reducing what's going on in the gut so people can can then enjoy a whole wide range of foods. I do think though I think you know, if you if you've got a chronic condition like psoriasis and you know, it's driven by stress, one of the things that I've observed in in clinic as well is that actually people want it to be a food intolerance. They want it to be something in the gut microbiome. And sometimes when it isn't, it's like much harder to address because when your nervous system is really disregulated and you have chronic stress and you don't know what to do about it, you will search for every other factor before looking at that. And that's the real quite often I found that's the nuts and bolts of how you get better is when you actually take away all this stuff and you think no it's really not that and it
1:00:55 worked for a bit then it stopped working then it comes down to that nervous system dysregulation from the chronic stress and it is that's then when it gets really life-changing but you do get a sustainable outcome when you go there but I wonder if that's why a lot of the initial recommendations for people on
…
