A 51 year old male presented with severe and extensive psoriasis, which had been present and worsening for 5 years. The psoriasis plaques covered all joint extensor surfaces, with large patches also on the lower legs, torso, underarms, scalp and genitals. This was causing considerable discomfort, and negatively impacting his sex life which was very distressing for him. He took oral corticosteroids intermittently to control the psoriasis, however this did not resolve the issue, and it immediately flared up on withdrawal of the medication. His specialist had recommended methotrexate, but he was reluctant to take this. Further questioning revealed that he had been diagnosed with Coeliac’s disease 10 years prior, but was not avoiding gluten. In fact, his diet was high in gluten, and he believed that because he didn’t get digestive discomfort after eating gluten, it was “not a big deal”.
Blood tests revealed very low vitamin D levels at 23 nmol/L (normal range >50 nmol/L, ideal >75 nmol/L), low vitamin B12 levels at 90 pmol/L (normal range >130 pmol/L, ideal >300 pmol/L), and elevated antigliadin antibodies.
Prescription
- Gluten-free diet
- Colecalciferol Spray 1000 IU: 5 sprays twice daily, providing 10,000 IU vitamin D
daily
- Sublingual B12 1000 mcg Tablets: 1 tablet twice daily under the tongue
- Liquid herbal blend 7.5 mL twice daily; containing Hemidesmus indicus
(Hemidesmus) root 1:2 30 mL, Hydrastis canadensis (Golden Seal) root 1:3
20 mL, Curcuma longa (Turmeric) root 1:1 40 mL, and Arctium lappa (Burdock)
root 1:2 10 mL
- Herbal cream: containing Berberis aquifolium (Oregan Grape) root, Coleus
forskohlii (Coleus) and Glycyrrhiza glabra (Licorice) root in a vitamin E base
cream; apply liberally twice daily
Follow Up – 4 Weeks
The psoriasis plaques were looking less inflamed, however there were no significant changes in the size or distribution. The patient had been compliant with his supplements, however he was not strictly avoiding gluten. After some initial effort, he decided it was too hard to change his diet. He lived alone and found cooking a chore, so he struggled to make himself healthy gluten-free meals from scratch. This meant that he reverted to eating convenience meals and takeaways that were not gluten-free. We did a lot of education this session around the consequences of consuming gluten when diagnosed with Coeliac disease, and particularly how this can drive psoriasis. We also looked at ways to make it easier to implement a strict gluten-free diet, such as:
- Using a gluten-free meal subscription service for main meals
- Providing very simple gluten-free meal and snack plans
- Providing a list of gluten-free brands and products, including ready-made meals
He was finding the herbal liquid a little hard to take and requested tablets instead.
Prescription
- Strict gluten-free diet
- Continue Colecalciferol Spray 1000 IU, Sublingual B12 1000 mcg Tablets, Gut
Repair Powder and Herbal cream
The patient was feeling good overall and had implemented a strict gluten-free diet. He found the gluten-free meal subscription service particularly helpful as it suited his lifestyle as a single person with limited cooking skills. He intended to continue this service long-term. The psoriasis had improved, being less inflamed overall and significantly less widespread. Follow up testing showed that vitamin D was now 80 nmol/L and vitamin B12 was 140 pmol/L.
Prescription
- Continue strict gluten-free diet
- Colecalciferol Spray 1000 IU: Reduce to 1 spray daily
- Sublingual B12 1000 mcg Tablets: Reduce to 1 tablet daily
- Gut Repair Powder: Continue 2 teaspoons twice daily
- Autoimmune Support Tablets: Continue2 tablets twice daily
- Intestinal Barrier Probiotic Sachets: 1 sachet daily; containing Bifidobacterium
bifidum W23, B. lactis W51, B. lactis W52, Lactobacillus acidophilus W37, L.
brevis W63, L. casei W56, L. salivarius W24, L. lactis W19 and L. lactis W58, total
5 billion CFU
- Herbal Cream: Apply to affected areas twice daily
Long Term Follow Up- 12 Months
The patient has maintained excellent compliance with his gluten-free diet and his supplements. The psoriasis is now very well controlled, generally limited to a few small patches on extensor surfaces of his elbows. He has noticed that the psoriasis flares up when he is under stress, which has been often recently. His blood tests show normal vitamin D and B12 levels, and anti-gliadin antibodies are now low.
Ongoing Prescription
- Continue strict gluten-free diet for life
- Wired & Tired Tablets: 2 tablets once or twice daily as needed; containing Withania somnifera (Withania) root 950mg, Glycyrrhiza glabra (Licorice) root
750mg, Scutellaria lateriflora (Skullcap) herb 470 mg, and Panax ginseng
(Korean Ginseng) root 100mg
Even the best health advice is only helpful when it is implemented. The key to successful treatment in this case was finding a way to help the client implement a gluten-free diet that was manageable for him. Dietary and lifestyle advice that seem simple to us as healthcare practitioners can be overwhelming for our clients. Sometimes we need to find creative solutions to help our clients make the changes needed to support their health.
