Help for Kim Kardashian's Psoriasis - Prescriptive Optimization

Kim Kardashian has a huge following, and they gobble up anything she puts out. I saw an article headline about her psoriasis last week; Kim Kardashian Just Shared Her Makeup-Free “Psoriasis Face”.

This quote stuck out: “I’m always hoping for a cure, of course, but in the meantime, I’m learning to just accept it as part of who I am.” While not letting a condition define you is admirable, I believe she can exert more control over the situation – read on for my recommendations.

Psoriasis

Psoriasis is an autoimmune condition, this is when the immune system is overactive and takes destructive action on our own cells.

“T cells normally travel through the body to defend against foreign substances, such as viruses or bacteria.

But if you have psoriasis, the T cells attack healthy skin cells by mistake, as if to heal a wound or to fight an infection.

Overactive T cells also trigger increased production of healthy skin cells, more T cells and other white blood cells, especially neutrophils. These travel into the skin causing redness and sometimes pus in pustular lesions. Dilated blood vessels in psoriasis-affected areas create warmth and redness in the skin lesions.

The process becomes an ongoing cycle in which new skin cells move to the outermost layer of skin too quickly — in days rather than weeks. Skin cells build up in thick, scaly patches on the skin’s surface, continuing until treatment stops the cycle.” ²

T cells

The immune system is complex. One player, T cells, the thymus produces which take part in the immune response. B cells typically involve antibody production. Since psoriasis in involves T cells, lets dive a little deeper.

T cells don’t operate on their own. They rely on an interplay of T regulatory (Treg) and helper cells (Th1, Th2, Th17) to fine-tune the immune response. As the interplay gets unbalanced, the response can become inappropriate, manifesting as autoimmunity. Th17 is increased in psoriasis ³ . ⁴ .

Th17 is pro inflammatory (through interleukin 23, Il-23), which is helpful to correct acute insults, not so much long term.

Th17 and Treg are areas in which we can exert some influence, and they tend to operate on opposing paradigms – Tregs keep Th17 in check.

Lectins

Lectins are sugar-binding proteins and are a defense mechanism in many plants/seeds. They are not good or bad as a group, but they can provoke the immune system. Guess what part of the immune system? Th17! Some receptors meant for identifying pathogens and triggering Th17 to fire are also activated by certain lectins ⁵ .

The main sources of lectins are:

Grains (wheat, corn, and other seeds of grasses)
Nightshade vegetables (tomatoes, potatoes, peppers, etc)
Legumes (beans, peas)
peanuts, cashews (these are actually legumes too, not classical nuts)
Squash, zucchini

Dairy (the protein component, not the fat) also has a lectinlike component:

About two thousand years ago, a spontaneous mutation in Northern European cows caused them to make the protein casein A-1 in their milk instead of the normal casein A-2. During digestion, casein A-1 is turned into a lectinlike protein called beta-casomorphin. This protein attaches to the pancreas’s insulin-producing cells, known as beta cells, which prompts an immune attack on the pancreas of people who consume milk from these cows or cheeses made from it.5 This is likely a primary cause of type 1 diabetes. ⁶

Lectins in wheat can precipitate gallbladder disease via a different mechanism, full details are available here.

mTOR/AMPK

These alphabet soup pathways are influenced by the feeding state of the body. mTOR is a growth signal ramped up by protein consumption and insulin. AMPK is an energy sensor that gets increased when there is an energetic deficit (exercise, fasting, caloric restriction) – this helps precipitate fat burning mode. They think both lowering mTOR and increasing AMPK to be critical in extending longevity.

Most people operate with mTOR continually active and AMPK relatively low. We are a continually fed population.

Psoriasis Strategies

I will focus on the non-prescription options, even though as a pharmacist I could talk about the $38,000 annual sales opportunities per patient in biologic drugs approved for psoriasis ⁸ .

Lectin Avoidance

There are two ways to reduce lectin impacts. Avoidance and blunting their effects.

Avoiding at least those on the list above, and then even working back in after a period of time to see if any reaction happens – a kind of elimination trial. See here for more useful tips.

The next level goes deeper. SelfHacked has a full program with detailed menus and lots of information on lectin avoidance. They are well researched and if you are looking to go hard on lectin avoidance, this is a great place to start.

The other angle is to supplement with decoys that occupy the lectins so they don’t bind elsewhere in the body and activate Th17. Glucosamine (N-acetyl glucosamine, NAG) and other supplements have a high affinity for many lectins and can bind to them ⁹ . This can definitely come in handy as how many Americans want to avoid something with tomato sauce for prolonged periods of time! We have a couple choices available here: (1) Plain NAG (Amazon) and (2) Lectin Control Formula (Amazon) with NAG and other lectin binders.

Two experiences

I have two daughters and each have experiences for the above strategies.

One is daughter sensitive to A1 dairy proteins. Any dairy product with lower fat such as milk (cheese, cream are ok) change her personality within the hour. I can tell without even knowing what she had that there was a Frappuccino or hot chocolate milk somewhere. It sets off some kind of process that makes her interact with us completely out of character, to where she now realizes this and stays clear. This is likely brain inflammation, see my whitepaper here, but in someone with psoriasis, any increase in inflammation involving Th17 is counterproductive.

I have another daughter who was getting headaches. I grew up with them (not any more!), my dad had them all the time, so this is not out of the ordinary. One day she mentioned she noticed a trend that every 4H meeting on Monday she would get a headache. Well, we have fallen into a predictable cycle where we cook spaghetti every Monday, with brown rice noodles. Tomato sauce and brown rice (or any other whole grain product) have high lectin content. She now supplements with a lectin blocker during this meal, and the headaches don’t happen. This was a helpful observation by her, and an important lesson in the importance of a food journal. Full Article Here.

Keto and intermittent fasting

Keto diets tend to avoid lectins just by the carb restriction alone. If adding even a slight calorie deficit (burning more than you eat), AMPK ramps up nicely. When you are ketogenic, fat is burned as the primary fuel, which, as we showed above, helps suppress Th17. Combine this with intermittent fasting, consuming your meals in a defined window – less than 12 hours, you can create a synergistic rise in AMPK and reduction in mTOR.

Ketogenic diets have a high rate of failure if not done properly. The copious information on the web makes it hard to pull off since much of it is wrong. Working with a provider trained and experienced in these diets can be helpful. Part of that training should include that keto diets should not be a religion nor a permanent way of life. They are a wonderful tool to be used strategically and periodically.

Leaky Gut

Most skin problems start in the gut according to what I have read over the years. I summarized in this article the mechanisms. While it may not be the major mechanism involved in all psoriasis cases ¹⁰ , my guess is that leaky gut contributes much of the time.

Other Strategies

So here is a list of recommendations to first focus on reducing Th17 cells and increasing regulatory T cells from a class from SelfHacked I took on inflammation. “These include:
●  Getting enough sun exposure. You want to work up to 1 hour/day to get all the benefits of reducing inflammation.
●  Increasing short chain fatty acids in the gut by eating resistant starch, such as hi-maize or potato starch. You just have to find a source of resistant starch that you tolerate. Butyrate supplementation is also an option.
●  Taking probiotics and prebiotics can help with regulating the immune system as well, again only if you tolerate it.
●  Black cumin seed oil, fish oil with DHA, sulforaphane are good supplements that help reduce inflammation and balance the immune system.
●  You want to make sure you have adequate vitamins and minerals that the immune system uses, including vitamins A, B, C, D, and selenium, zinc, and iron.
●  CBD is a really powerful anti-inflammatory. It also helps reduce Th17 and increase Tregs.
●  You want to manage stress really well, and entrain your circadian rhythm.
●  Exercise is also a good way to balance the immune system.
●  Lastly, there’s fasting and red light therapy that can reduce inflammation and
support immune balance. But these two are optional.”

Kim’s Diet/Lifestyle Opportunities

Based on what I have read online, let’s see if we can offer opportunities for additional methods she, or someone else in a similar position, can use to battle psoriasis.

Diet

According to this article Kim has been using a keto diet since her last pregnancy to lose weight. Keto is on our strategies list above, however, I am not sure it is true keto after seeing her typical menu.

Breakfast: Blueberry oatmeal pancakes
Lunch: Chicken, sweet potato and vegetables
Dinner: Fish and vegetables
Drink: Four and a half litres a day

Oatmeal pancakes, while according to another page, don’t have wheat flour but do have ground oats. Oats are grains and have lectins. They are also notorious for Roundup (glyphosate) contamination ¹¹ . Two strikes for breakfast.

Chicken, unless free-range and organic, is not ideal. Lectin expert Stephen Gundry (read the notes I took from his book here) describes it as the least healthy white meat ¹² . Sweet potato, is a good carb but unless eats a small serving size this won’t allow her to keep in ketosis. Vegetables can be good, but depending on the selections, lectins can creep in.

Fish is great if wild-caught. Same precaution on the vegetables, she is likely consuming lectins here too.

Chicken Cacciatore, which she is making in the above pic, is a chicken dish topped with tomatoes and bell peppers in some recipes ¹⁴ . Chicken (lectin), topped with tomatoes (lectins), peppers (lectins), served with what looks to be a salad topped with cherry tomatoes (yes, more lectins!). The Atkins bars she is promoting here are also lectin bombs, containing most of the avoid recommendations and adding inflammatory seed oils to boot. Not good for psoriasis!

Interesting aside, Italians typically peel and de-seed their tomatoes, avoiding the lectin content. Here is a good article on that process.

Let’s look at a protein shake she is promoting and credits to success in weight loss, unfortunately, combined with lectin effects of milk (you did notice the milk right? FOCUS!).

INGREDIENTS¹⁶
Pea protein isolate, inulin, brown rice protein, hydroxycitric acid from the dried fruit rind of Garcinia Cambogia (Super CitriMax®), natural French vanilla flavor, natural vanilla flavor, flaxseed (Bevgrad® Xtrasmooth), xanthan gum, cocoa, milled white chia seed, tricalcium phosphate, purified sea salt, magnesium oxide, plum, beet, raspberry, yumberry, enzyme blend (Pepzyme® AG), probiotic dairy (Lactobacillus acidophilus, Bibidobacterium bifidum, Bifidobacterium longum, Bifidobacterium lactis), black currant, blackberry, trap, luo han guo (monk fruit)(Go-Luo®), pomegranate, stevia leaf extract, red grape, banana, blue honeysuckle berry, blueberry, dark sweet cherry, eggplant, guava, purple sweet potato, red bell pepper, red pepper, strawberry, sweet cherry, tomato, watermelon, orange, carrot, cranberry, purple cabbage, cucumber, mango, peach, spinach, zinc amino acid chelate, acerola cherry, apple, kale, ascorbic acid, ferrous fumarate, kiwi, acai, broccoli, Brussel sprouts, asparagus, boy chop, butternut squash, green bean, green pea, lemon, lime, mung bean, parsley leaf, pineapple, pumpkin, star fruit, sweet potato, yellow bell pepper, selenium amino acid chelate, d-alpha tocopherol acetate, niacinamide, copper amino acid chelate, iodine amino acid chelate, manganese amino acid chelate, d-calcium pantothenate, chromium amino acid chelate, vitamin A palmitate, pyridoxine HCI, riboflavin, thiamine HCI, d-biotin, folic acid, beta carotene, ergocalciferol and cyanocobalamin.

Pea protein and brown rice are high lectin, and being listed as 2 of the top 3 ingredients indicates a significant source, plus the peppers further down the list. In addition, at least according to the picture, mixed with milk which leads to another source of lectin-like proteins.

I don’t think the term keto appropriately describes her diet. This is common. Keto is not just a low carb, it is high in quality fats (I didn’t see any significant source), and moderate in protein. Nothing above in her diet would lead to nutritional ketosis, typically defined as a blood level of the ketone beta-hydroxybutyrate of 0.5mmol/L. There is hardly any fat found, high protein, low/moderate carbohydrates.

Further, she is getting lectins all day, ramping up her Th17 and potentially contributing to psoriasis flares.

Sun

Kim is known for lots of bikini pics, so you think she would be good on the sun exposure front. However, she is blunting the positive sun effects if this article is accurate in quoting Kim ¹⁷ :

“In my daily skincare routine, I always make sure to wear products that have SPF!” she writes on her site. “It’s so important for protection, preventing fine lines, wrinkles and discoloration.” And in case you’re the type to only break out the sunscreen when you’re in, well, the sun, just know SPF is just as important in the winter as it is when you’re lying on a beach or dancing at Coachella. And believe it or not, it’s not just sunscreen that’ll give you SPF coverage. “If you don’t like sunscreen on your face, there are a lot of skincare options that still have coverage — everything from primers and oils to foundations and sprays,” she continued. These are some of the products Kim adds to her routine that protect her skin from the sun, but don’t feel like sunscreen.

It is hard for the sun to get to the psoriasis patches and work its magic if behind makeup with SPF +/- additional sunscreen. Even the National Psoriasis Foundation recommends omitting sunscreen on the affected areas ¹⁸ .

Take Away

I like that Kim shared her struggle, bringing attention to these conditions can get discussions (like this one) going. We don’t know how much of the reports are accurate, but it looks like she isn‘t getting great advice on how to take a more active role in battling this disease. Further, the presentation available publicly shows she engages diet and lifestyle measures that escalate Th17 and the T cell-based immune response integral to psoriasis.

It is not that lectins have to be avoided for all people – they should be monitored to determine your individual response. Keep in mind, inflammation isn’t always something we notice if it is not from an injury – things like brain fog could signal an escalation. For someone with an inflammatory or autoimmune condition, like psoriasis, lectins are easily a high priority for heightened focus and management.

If I have someone asking me about psoriasis, I would highly recommend the strategies above. If you or someone you know would like assistance here, please reach out for a free consultation. If you happen to be one of the 100 million+ followers of Kim on social media, please forward this to her – it would be fascinating to know if this information can help her. If it helps Kim, her influence could help thousands with this difficult malady.

Help for Kim Kardashian’s Psoriasis

Psoriasis

T cells

Lectins

mTOR/AMPK