Psoriasis is a long-term, chronic skin disease that affects about 1.1 million people in the UK. If you are genetically predisposed to it, it can be triggered by anything from a throat infection to a period of stress, leading to itchy, scaly, and often painful patches of skin around the body. It is commonly found on the knees, elbows, trunk and scalp, and can affect your ability to sleep and concentrate.
There are several forms of therapy, including topical ointments, light therapy and injections to help manage psoriasis and slow the growth. However, there is no cure. This means that many with psoriasis, including Dr David Fox, a GP based in Hastings and father of two, find ways to live with the disruptive condition.
But while trying a new way of eating, the 42-year-old GP found that there was another way to manage, and even get rid of, his psoriasis. Here he tells i about how eating low carb has been an enlightening, and skin-clearing, process.
I’ve had psoriasis since I qualified as a GP in 2010 when I was 28. It was a really stressful time for me, which I imagine was a trigger. Once it’s triggered, it can hang around as a long-term condition.
I lived with it on my scalp, arms and legs for a long time. You can keep it covered if it’s on your arms and legs, but psoriasis on the scalp is difficult. Because it was so visible, people would comment and it was a nightmare to manage. You’re constantly flaking as if you’ve got heavy dandruff, it’s sore, and you constantly scratch. I’m not a particularly vain man, but it was very visible when my hair was cut short and would make me uncomfortable.
Obviously, as a GP, I see far worse things than psoriasis, so I wasn’t feeling too sorry for myself. But it can be hard to find manageable treatments. I used steroid-based creams and they were always effective in the short term, but if I stopped using them, the psoriasis would come back – plus, it was hard to use them on my scalp. I didn’t feel my condition was serious enough to take the immunosuppressant drugs – they can be very effective but also risk side effects, including severe infections, as they affect the whole immune system.
I hadn’t really thought about food being a trigger for psoriasis. I knew that alcohol, which is a common psoriasis trigger, was a trigger for me but I didn’t really connect the dots between the problem with alcohol being its carbohydrate content. However last year, out of curiosity and listening to a colleague’s advice, I started following the keto diet. I wasn’t thinking about my psoriasis at all, but I wanted to see if it would make me feel a bit better and healthier.
There are some doctors who make living a healthy lifestyle their ‘thing’, but I, like a lot of other GPs, didn’t really look after myself. I kept focusing on reducing calories and doing more exercise, eating lots of carbs such as bread and potatoes, always having a pudding and drinking regularly. Eating keto and then low carb was my way of claiming back my health, and it became a major eye-opener to how diet could run the body’s inflammatory system.
Following the keto diet, you keep your carbohydrates down to about 20 grams a day, which shifts your body from a state dependent on burning glucose to one dependent on burning fat. This means your energy source is fat itself, and when they are used as energy, they release ketones. Before going on the diet, I’d have had toast or porridge, a wrap at lunch and pasta or potatoes at dinner; after, I was instead filling up on cheese, meats, eggs, some fish, such as anchovies, and dark green vegetables like kale or broccoli.
It will always lead to weight loss, and people will find that inflammatory conditions will settle because the inflammation can be caused by sugar consumption. But you will also have other potential benefits – I found I had more energy and slept better after a few weeks.
Within a month, my skin became less actively inflamed and then the patches steadily decreased. After 10 months this psoriasis I’d had since 2010 was gone.
Experiencing those benefits definitely makes the diet easier to stick to. But there is some risk to doing keto, especially if you don’t do it properly, so I would not always recommend it without doing proper and thorough research.
While eating keto, I found the need to supplement with zinc and biotin to prevent hair thinning. You won’t notice the effects straight away (as it takes time for your hair to change) but you need to really keep up the right supplementation.
After doing keto for about four months, I’d lost enough weight and felt that I could relax my diet a bit and move onto a low carb version – instead of limiting yourself to 20 grammes of carbs a day, on low carb you’re aiming generally below 90, which is equivalent of one portion in a balanced meal kit such as Gousto. This meant I could reintegrate eating with my family and all the other things you have to sacrifice by eating a diet that’s not suitable for everyone else. During the time I was keto, the only place I could find the right kind of food when out and about was in M&S, shopping from the supermarket’s ‘three for £8’ deli section – that was where I did most of my shopping for work. You have to be very, very organised and plan carefully and that’s not always possible.
Many NHS professionals, and colleagues of mine, are very interested in intermittent fasting and low carb diets. It’s very helpful for people who do shift work and helps them to keep their weight down. There are examples around the UK where they are bringing low carb as an option to their patients who are prediabetic (at the highest risk of developing diabetes) and those with diabetes who aren’t on insulin. I do recommend it to some of my patients – we have started support groups at our practice for diabetics to offer them low carb support, and we’ve had some great progress there.
It is, however, only an option. It overlaps with the movement against ultra-processed foods (UPF) because avoiding UPFs leads to a low carb, low sugar kind of diet. The Mediterranean diet, too, is effectively a low carb diet. And it’s not as extreme or hard to sustain as eating keto. It’s just the framing (‘reduce carbs and reduce sugar’) that seems to be linking all of these things together. That makes it easy for patients to understand and therefore becomes more about common sense. And there are lots of resources out there to make sure what you do is safe. I tend to recommend the Freshwell online resources which are very patient friendly.
I see that period spent doing keto as a period of enlightenment that made me realise what was possible with my diet, and staying low carb is how I sustain it. I feel amazing – my hunger reflex has gone down, I don’t crave sugar, I can eat with my growing family, and my sleep, energy and psoriasis have all improved dramatically. This is how I want to feel all the time.